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HELLP Syndrome
Paula J. Woodward, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Abbreviations

          • Hemolysis, elevated liver enzymes, low platelets (HELLP)
        • Definitions

          • HELLP syndrome is serious variant of preeclampsia seen primarily in young primigravidas
          • American College of Obstetricians & Gynecologists laboratory criteria for HELLP syndrome
            • Hemoglobin < 11 g/dL
            • Bilirubin > 1.2 mg/dL
            • Lactate dehydrogenase > 600 U/L
            • Aspartate aminotransferase > 70 U/L
            • Platelet count < 100,000/mm³

        IMAGING

        • General Features

          • Ultrasonographic Findings

            • CT Findings

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Gross Pathologic & Surgical Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Yildirim G et al: HELLP syndrome: 8 years of experience from a tertiary referral center in western Turkey. Hypertens Pregnancy. 31(3):316-26, 2012
                                      2. Guzel AI et al: Are maternal and fetal parameters related to perinatal mortality in HELLP syndrome? Arch Gynecol Obstet. 283(6):1227-32, 2011
                                      3. Keiser SD et al: HELLP Syndrome with and without Eclampsia. Am J Perinatol. 28(3):187-94, 2011
                                      4. Yucesoy G et al: An analysis of HELLP syndrome cases: does platelet count predict adverse maternal and fetal outcomes in women with HELLP syndrome? Arch Gynecol Obstet. 283(5):941-5, 2011
                                      5. Wang YQ et al: Investigation of diagnosis and treatment of hemolysis-elevated liver enzymes-low platelet counts (HELLP) syndrome: clinical analysis of 59 cases. Chin Med J (Engl). 123(10):1273-7, 2010
                                      6. Woudstra DM et al: Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy. Cochrane Database Syst Rev. 9:CD008148, 2010
                                      7. Gasem T et al: Maternal and fetal outcome of pregnancy complicated by HELLP syndrome. J Matern Fetal Neonatal Med. 22(12):1140-3, 2009
                                      8. Haram K et al: The HELLP syndrome: clinical issues and management. A Review. BMC Pregnancy Childbirth. 9:8, 2009
                                      9. Lee NM et al: Liver disease in pregnancy. World J Gastroenterol. 15(8):897-906, 2009
                                      10. Miguelote RF et al: Postpartum spontaneous rupture of a liver hematoma associated with preeclampsia and HELLP syndrome. Arch Gynecol Obstet. 279(6):923-6, 2009
                                      11. Pavlis T et al: Diagnosis and surgical management of spontaneous hepatic rupture associated with HELLP syndrome. J Surg Educ. 66(3):163-7, 2009
                                      12. Hay JE: Liver disease in pregnancy. Hepatology. 47(3):1067-76, 2008
                                      13. Vinnars MT et al: Severe preeclampsia with and without HELLP differ with regard to placental pathology. Hypertension. 51(5):1295-9, 2008
                                      14. Mihu D et al: HELLP syndrome - a multisystemic disorder. J Gastrointestin Liver Dis. 16(4):419-24, 2007
                                      15. O'Brien JM et al: Controversies with the diagnosis and management of HELLP syndrome. Clin Obstet Gynecol. 48(2):460-77, 2005
                                      16. Moodley J: Maternal deaths associated with hypertensive disorders of pregnancy: a population-based study. Hypertens Pregnancy. 23(3):247-56, 2004
                                      17. Di Salvo DN: Sonographic imaging of maternal complications of pregnancy. J Ultrasound Med. 22(1):69-89, 2003
                                      18. Marsh FA et al: Surviving hepatic rupture in pregnancy--a literature review with an illustrative case report. J Obstet Gynaecol. 23(2):109-13, 2003
                                      19. Suarez B et al: Abdominal pain and preeclampsia: sonographic findings in the maternal liver. J Ultrasound Med. 21(10):1077-83; quiz 1085-6, 2002
                                      20. Reck T et al: Surgical treatment of HELLP syndrome-associated liver rupture -- an update. Eur J Obstet Gynecol Reprod Biol. 99(1):57-65, 2001
                                      21. Casillas VJ et al: Imaging of nontraumatic hemorrhagic hepatic lesions. Radiographics. 20(2):367-78, 2000
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Hemolysis, elevated liver enzymes, low platelets (HELLP)
                                            • Definitions

                                              • HELLP syndrome is serious variant of preeclampsia seen primarily in young primigravidas
                                              • American College of Obstetricians & Gynecologists laboratory criteria for HELLP syndrome
                                                • Hemoglobin < 11 g/dL
                                                • Bilirubin > 1.2 mg/dL
                                                • Lactate dehydrogenase > 600 U/L
                                                • Aspartate aminotransferase > 70 U/L
                                                • Platelet count < 100,000/mm³

                                            IMAGING

                                            • General Features

                                              • Ultrasonographic Findings

                                                • CT Findings

                                                  • MR Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Gross Pathologic & Surgical Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Yildirim G et al: HELLP syndrome: 8 years of experience from a tertiary referral center in western Turkey. Hypertens Pregnancy. 31(3):316-26, 2012
                                                                          2. Guzel AI et al: Are maternal and fetal parameters related to perinatal mortality in HELLP syndrome? Arch Gynecol Obstet. 283(6):1227-32, 2011
                                                                          3. Keiser SD et al: HELLP Syndrome with and without Eclampsia. Am J Perinatol. 28(3):187-94, 2011
                                                                          4. Yucesoy G et al: An analysis of HELLP syndrome cases: does platelet count predict adverse maternal and fetal outcomes in women with HELLP syndrome? Arch Gynecol Obstet. 283(5):941-5, 2011
                                                                          5. Wang YQ et al: Investigation of diagnosis and treatment of hemolysis-elevated liver enzymes-low platelet counts (HELLP) syndrome: clinical analysis of 59 cases. Chin Med J (Engl). 123(10):1273-7, 2010
                                                                          6. Woudstra DM et al: Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy. Cochrane Database Syst Rev. 9:CD008148, 2010
                                                                          7. Gasem T et al: Maternal and fetal outcome of pregnancy complicated by HELLP syndrome. J Matern Fetal Neonatal Med. 22(12):1140-3, 2009
                                                                          8. Haram K et al: The HELLP syndrome: clinical issues and management. A Review. BMC Pregnancy Childbirth. 9:8, 2009
                                                                          9. Lee NM et al: Liver disease in pregnancy. World J Gastroenterol. 15(8):897-906, 2009
                                                                          10. Miguelote RF et al: Postpartum spontaneous rupture of a liver hematoma associated with preeclampsia and HELLP syndrome. Arch Gynecol Obstet. 279(6):923-6, 2009
                                                                          11. Pavlis T et al: Diagnosis and surgical management of spontaneous hepatic rupture associated with HELLP syndrome. J Surg Educ. 66(3):163-7, 2009
                                                                          12. Hay JE: Liver disease in pregnancy. Hepatology. 47(3):1067-76, 2008
                                                                          13. Vinnars MT et al: Severe preeclampsia with and without HELLP differ with regard to placental pathology. Hypertension. 51(5):1295-9, 2008
                                                                          14. Mihu D et al: HELLP syndrome - a multisystemic disorder. J Gastrointestin Liver Dis. 16(4):419-24, 2007
                                                                          15. O'Brien JM et al: Controversies with the diagnosis and management of HELLP syndrome. Clin Obstet Gynecol. 48(2):460-77, 2005
                                                                          16. Moodley J: Maternal deaths associated with hypertensive disorders of pregnancy: a population-based study. Hypertens Pregnancy. 23(3):247-56, 2004
                                                                          17. Di Salvo DN: Sonographic imaging of maternal complications of pregnancy. J Ultrasound Med. 22(1):69-89, 2003
                                                                          18. Marsh FA et al: Surviving hepatic rupture in pregnancy--a literature review with an illustrative case report. J Obstet Gynaecol. 23(2):109-13, 2003
                                                                          19. Suarez B et al: Abdominal pain and preeclampsia: sonographic findings in the maternal liver. J Ultrasound Med. 21(10):1077-83; quiz 1085-6, 2002
                                                                          20. Reck T et al: Surgical treatment of HELLP syndrome-associated liver rupture -- an update. Eur J Obstet Gynecol Reprod Biol. 99(1):57-65, 2001
                                                                          21. Casillas VJ et al: Imaging of nontraumatic hemorrhagic hepatic lesions. Radiographics. 20(2):367-78, 2000