History and exam

Key diagnostic factors

common

nausea/vomiting

Caused by liver dysfunction.

Occurs in 29% to 84% of patients.[1][5][55][56]

hypertension

Secondary to vasoconstriction.

Occurs in 33% to 88% of patients.[1][5][55][56]

brisk tendon reflexes

A key finding in the physical examination of patients with pre-eclampsia and therefore with HELLP syndrome.

Other diagnostic factors

common

right upper quadrant/epigastric pain and tenderness

Caused by liver ischaemia and necrosis.

Occurs in 40% to 90% of patients.[1][5][55][56]

generalised malaise

Occurs in 90% of patients.[1][5][55][56]

headache

Occurs in 33% to 61% of patients.[1][5][55][56]

oedema

Occurs in about two-thirds of patients.[1][5][55][56]

uncommon

visual disturbances

Occurs in <20% of patients.[1][5][55][56] If visual loss is present, especially in association with headache, the patient may be developing posterior reversible encephalopathy syndrome and thus be at risk of an eclamptic seizure.

jaundice

A rare manifestation.

bleeding

Bleeding manifestations (e.g., haematuria) are rare.

Risk factors

strong

white ethnicity

More common in white people.[1]

maternal age >35 years

Advancing maternal age (>35 years) is a risk factor in the development of HELLP syndrome.[1][34]

obesity

A high body mass index is associated with the development of HELLP syndrome. Unlike other important risk factors, body weight is potentially modifiable.[35]

chronic hypertension

Patients with chronic hypertension and vascular disorders are at higher risk of pre-eclampsia and therefore of HELLP syndrome.[1][36]​

diabetes mellitus

Patients with diabetes are at higher risk of pre-eclampsia and therefore of HELLP syndrome.[1]

autoimmune disorders

Patients with immune disorders, such as systemic lupus erythematosus, are at higher risk of pre-eclampsia and therefore of HELLP syndrome.[1]

migraine

Pregnant people with a history of migraine are at increased risk of hypertensive disorders of pregnancy, including HELLP syndrome.[37][38][39]

abnormal placentation (e.g., molar pregnancy)

Patients with abnormal placentation are at increased risk of pre-eclampsia and therefore of HELLP syndrome.[1]

previous pregnancy with preeclampsia with/without HELLP syndrome

Up to 20% to 40% of normotensive patients with a history of prior HELLP syndrome will have some form of pre-eclampsia in a subsequent pregnancy. This rate increases to 75% in those with underlying hypertensive disorders.[41][42][43][44]

weak

multiple gestation

Patients with multiple gestation are at increased risk of pre-eclampsia and therefore of HELLP syndrome.[1][40]

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