What Is HELLP Syndrome and How Is It Different From Preeclampsia?

HELLP syndrome is a serious hypertensive disorder of pregnancy defined by three laboratory findings: Hemolysis (red blood cells breaking down), EL (elevated liver enzymes), and LP (low platelet count). It is closely related to preeclampsia and eclampsia, but it can develop without the classic warning sign of high blood pressure, which is why it is easy to miss. If you are pregnant or recently postpartum and have severe upper abdominal pain, nausea, headache, or vision changes, treat it as an emergency and contact your obstetric provider or go to the emergency department.

What the letters HELLP stand for

These three problems together can progress quickly and affect the liver, blood clotting, and other organ systems.

Symptoms to watch for

HELLP can cause symptoms that overlap with many other pregnancy complaints, so severity and suddenness matter. According to the Preeclampsia Foundation, hypertensive disorders of pregnancy are most often characterized by a rapid rise in blood pressure that can lead to seizure, stroke, multiple organ failure, and even death of the mother and/or baby.

Common warning signs include:

• Pain in the upper right abdomen or upper abdomen (often described as severe or persistent)
• Nausea and vomiting
• Headache that does not go away
• Vision changes, such as blurring or seeing spots
• Fatigue or feeling generally unwell

Because these symptoms can look like ordinary late-pregnancy discomfort, do not wait to see if they pass. Report them right away.

How HELLP differs from preeclampsia and eclampsia

Preeclampsia, eclampsia, and HELLP are all part of the same family of hypertensive disorders of pregnancy. They overlap, but they are not identical:

• Preeclampsia is generally identified by high blood pressure and signs of organ involvement (such as protein in the urine or other lab abnormalities) after about 20 weeks of pregnancy.
• Eclampsia is preeclampsia that progresses to seizures.
• HELLP syndrome is defined by its laboratory findings (hemolysis, elevated liver enzymes, low platelets). It can occur with preeclampsia, but it can also appear when blood pressure is not dramatically elevated, which is one reason it may be overlooked.

In other words, HELLP is not simply "severe preeclampsia with a different name." It is a related but distinct condition that can present atypically.

Timing: it can happen during pregnancy or after delivery

HELLP can occur during pregnancy or in the postpartum period. Postpartum onset means symptoms can appear after you have given birth, when you may assume you are past the danger window. The Preeclampsia Foundation lists postpartum preeclampsia and HELLP syndrome among the conditions it covers, and postpartum symptoms still require immediate medical attention.

If you have recently delivered and develop severe abdominal pain, headache, vision changes, or feel suddenly very unwell, seek care immediately and tell the provider you are postpartum.

How it is diagnosed and treated

Diagnosis is based on blood tests, typically including a complete blood count (to check platelets and signs of hemolysis) and liver function tests (to check liver enzymes). Your provider may also order other tests to assess how your organs are functioning.

The definitive treatment is delivery of the baby, because the condition resolves only after the pregnancy ends. Management before delivery focuses on stabilizing the mother, monitoring labs, and controlling blood pressure and any complications. The exact timing and approach depend on gestational age, severity, and maternal and fetal status, and should be decided by the obstetric team.

When to get help immediately

Contact your obstetric provider or emergency services right away if you have:

• Severe or persistent upper right or upper abdominal pain
• Nausea and vomiting that is new or worsening
• A headache that will not go away
• Vision changes
• Sudden swelling, especially of the face or hands
• Any feeling that something is seriously wrong

Do not drive yourself if you feel unwell. Call for help or have someone take you.

Where to learn more

The Preeclampsia Foundation (preeclampsia.org) provides patient education on preeclampsia, eclampsia, HELLP syndrome, and postpartum preeclampsia, along with support resources and ways to participate in research. Its stated purpose is to improve outcomes of hypertensive disorders of pregnancy through education, support, community engagement, better healthcare practices, and accelerated research.