At what stage in pregnancy does HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet count) syndrome occur?

From the Guidelines

HELLP syndrome typically occurs during the third trimester of pregnancy, usually after 27 weeks, as seen in a case report of a 25-year-old patient with a twin pregnancy of 34 weeks gestation who developed HELLP syndrome 1.

Key Characteristics of HELLP Syndrome

• Hemolysis (breakdown of red blood cells)
• Elevated Liver enzymes
• Low Platelet count

Clinical Presentation

• Symptoms include headache, nausea, vomiting, upper right abdominal pain, and general malaise
• Can develop earlier or even postpartum (within 48 hours after delivery)

Importance of Early Detection and Treatment

• HELLP syndrome requires immediate medical attention as it can lead to serious complications including liver rupture, placental abruption, kidney failure, pulmonary edema, and disseminated intravascular coagulation
• The definitive treatment is delivery of the baby, regardless of gestational age, though medications may be given to stabilize the mother's condition, control blood pressure, and prevent seizures (typically magnesium sulfate) before delivery can occur

Diagnosis and Management

• Diagnosis is based on laboratory investigations, including hemoglobin, platelet count, prothrombin time, activated partial thromboplastin time, serum concentration of fibrinogen, and liver function tests
• Management involves extensive preoperative preparation and invasive monitoring, as well as correction of hypovolaemia and severe thrombocytopenia with fresh frozen plasma and platelets 1

From the Research

HELLP Syndrome Occurrence

• The HELLP syndrome is a serious complication in pregnancy characterized by hemolysis, elevated liver enzymes, and low platelet count, occurring in 0.5 to 0.9% of all pregnancies and in 10-20% of cases with severe preeclampsia 2, 3.
• About 70% of cases develop before delivery, the majority between the 27th and 37th gestational weeks; the remainder within 48 hours after delivery 2, 3.
• The syndrome typically occurs in the third trimester of gestation, with most cases manifesting between 32-34 weeks' gestation 4, 5.
• HELLP syndrome can also occur post-partum, with up to 30% of cases developing after delivery 5.

Gestational Age at Diagnosis

• The gestational age at diagnosis of HELLP syndrome can vary, but most cases occur between 27-37 weeks' gestation 2.
• One study found that the maternal age was 25.8 ±7.2 years and gestational age at diagnosis was 31 ± 1 week 6.
• Another study reported that the disease manifests itself on average between 32-34 weeks' gestation 5.

Timing of HELLP Syndrome

• HELLP syndrome can be classified as antepartum or postpartum, with the majority of cases occurring antepartum 6.
• The syndrome can also be classified as early or late, depending on whether it occurs before or after the 34th week of gestation 6.