HELLP syndrome

Last reviewed: 29 Dec 2022
Last updated: 29 Dec 2022



History and exam

Key diagnostic factors

  • nausea/vomiting
  • hypertension
  • brisk tendon reflexes
More key diagnostic factors

Other diagnostic factors

  • right upper quadrant/epigastric pain and tenderness
  • generalized malaise
  • headache
  • edema
  • visual disturbances
  • jaundice
  • bleeding
Other diagnostic factors

Risk factors

  • white ethnicity
  • maternal age >35 years
  • obesity
  • chronic hypertension
  • diabetes mellitus
  • autoimmune disorders
  • migraine
  • multiple gestation
  • abnormal placentation (e.g., molar pregnancy)
  • previous pregnancy with preeclampsia with/without HELLP syndrome
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC with differential including platelets
  • peripheral blood smear
  • liver transaminases
  • bilirubin level
  • total serum LDH level
  • uric acid level
  • urinalysis and protein-to-creatinine ratio
  • PT/PTT
  • fibrinogen level
  • fetal ultrasound
More 1st investigations to order

Investigations to consider

  • serum glucose level
  • serum creatinine and electrolyte levels
  • antithrombin level
  • haptoglobin level
  • maternal upper abdomen ultrasound, CT, or MRI
  • lactate dehydrogenase (LDH)-to-aspartate aminotransferase (AST) ratio
More investigations to consider

Treatment algorithm


suspected/presumed HELLP


all patients (confirmed HELLP)



James N. Martin, Jr, MD, FACOG, FAGOS, FAHA, F(H)RCOG

Professor Emeritus of Obstetrics, Gynecology, and Maternal-Fetal Medicine

University of Mississippi Medical Center




JNM Jr is an obstetrician-gynecologist and maternal-fetal medicine consultant to BlueCross & BlueShield of Mississippi and the Mississippi Perinatal Quality Collaborative. He is co-director of the Mississippi Maternal Mortality Review Committee. He serves on the Global Operations Advisory Group of the American College of Obstetricians and Gynecologists (ACOG), and in 2018-9 he chaired the ACOG Presidential Task Force on Pregnancy and Heart Disease. JNM Jr lectures, teaches, researches, and speaks nationally and internationally on the subjects of hypertensive complications of pregnancy, including HELLP syndrome. He is also the lead author and editor of "The 2015 compendium for HELLP syndrome: from bench to bedside" (Nova Biomedical Publishers). JNM Jr is an author of several references cited in this topic. He has cited his own papers in this topic.


Dr James N. Martin Jr would like to gratefully acknowledge Dr Marium G. Holland and Dr Alex C. Vidaeff, the previous contributors to this topic.


MGH declares that she has no competing interests. ACV is an author of a number of references cited in this topic.

Peer reviewers

Jerome Yankowitz, MD

Professor and Director

Division of Maternal-Fetal Medicine

Department of Obstetrics and Gynecology

University of Iowa Hospitals and Clinics

Iowa City



JY declares that he has no competing interests.

Deirdre Murphy, MD, MRCOG

Professor of Obstetrics

Trinity College

University of Dublin

Consultant Obstetrician

Coombe Women and Infants University Hospital




DM declares that she has no competing interests.

  • Differentials

    • Acute fatty liver of pregnancy (AFLP)
    • Thrombotic thrombocytopenic purpura (TTP)
    • Atypical hemolytic uremic syndrome (aHUS)
    More Differentials
  • Guidelines

    • ACOG practice bulletin no. 222: gestational hypertension and preeclampsia
    • Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy
    More Guidelines
  • Patient leaflets

    Preeclampsia: what is it?

    Preeclampsia: what treatments work?

    More Patient leaflets
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