Scary Shit Series – HELLP

We’ve previously covered preeclampsia on the blog and HELLP syndrome is a variant of that. HELLP is basically preeclampsia’s asshole, homicidal cousin.

It’s pretty rare, but very serious which is why we decided to write about it. HELLP syndrome shows up in about 1 or 2 of every 1,000 pregnancies. If you have preeclampsia, you have about 10-20% chance of developing HELLP syndrome (but you can get HELLP without developing preeclampsia first). About 1 in 4 women develop serious complications from HELLP and some of those women die, hence why this is some scary shit.

HELLP stands for:

H (hemolysis, when red blood cells break down so they can’t properly carry oxygen from your lungs to the rest of your body)


EL (elevated liver enzymes, which is super bad for your liver)

LP (low platelet count, which means your blood can’t clot properly)

To break that down further: your liver stops being able to effectively process toxins in your body and not being able to form blood clots means you could hemorrhage during delivery. Basically some very core systems get all screwed up and it is really bad news for your poor body.

We still aren’t sure exactly what causes HELLP syndrome. Symptoms usually crop up during pregnancy, typically during the third trimester, but for some women, HELLP isn’t diagnosed until childbirth or the few days after giving birth.

Symptoms include:

  • headache
  • nausea
  • fatigue
  • blurred vision
  • swelling in hands, face, and eyes, in particular
  • pain under ribs or in your shoulder (caused by an enlarged liver)
  • high blood pressure
  • protein in the urine

Many of those symptoms are preeclampsia giveaways, too. The reason HELLP is such a tricky bugger is that it can sometimes be present without (or before) preeclampsia and some of the symptoms look a lot like the flu or gallbladder disease. So a woman’s blood pressure is fine and there are no proteins in her urine and then suddenly out of nowhere HELLP rears its ugly head.

Early and fast treatment of HELLP is super critical. Similar to preeclampsia, treatment for a pregnant woman is typically: let’s get that baby out of you! You may also need a blood transfusion to replenish your busted up red blood cells, as well as medication to lower your blood pressure and anti-seizure medication.

I want to be clear that there’s nothing you can do to prevent HELLP. As Amy mentioned in the preeclampsia post, you don’t have to feel really sick to be really sick. What you can do is go to your regular prenatal checkups to have your pee and blood pressure checked and know the warning signs. Trust yourself if you think things feel wonky and then call your practitioner.

If you want more info on HELLP syndrome, check out the page further describing the syndrome on

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  • I thought I had really bad heartburn for several days but then one night it was so bad I couldn’t stop puking, I almost didn’t go to the ER because I still just thought it was heartburn (ended up being my liver shutting down)! Luckily I went to the hospital and at 35 weeks they had to have an emergency c-section. Even while I was spitting out blood while waiting to see if they could induce me, my blood pressure was perfect…effing’ HELLP! Luckily my daughter was healthy and only had to be in the NICU for 5 days. Never heard of it until the dr. said, “well, you’re having your baby today.”

  • Thanks so much! I founded the Preeclampsia Foundation after my own near-miss with HELLP in 1996. I joined the HELLP Syndrome Society and found a whole lot of support and we later merged with the PF. I love your article – we also founded the Unexpected Project (we have a Facebook page) for survivors of all manners of WTF – which is what I wanted to call the group and documentary we have been working on – but was talked down from the ledge by wiser, more tactful ladies who thought “Unexpected” was a nice wry understatement. THANK you for saying what I wish I’d had the courage to say.

  • The first I heard of HELLP Syndrome was six months after nearly dying of it. I sat in the neuro cognitive rehab clinic to which I’d been confined and googled it on my laptop, hoping to understand what had happened to me.

    How could a pregnancy that felt so easy–blissful even—turn so bad so fast?

    Was there anything my doctors or I could have done to prevent it?

    I will probably ponder these questions for the rest of my life.

    Thank you for helping to raise awareness of this disease!

  • Thank you so much for writing about this. I had HELLP, but blessedly relatively late in my pregnancy. Baby and I made it to 38.5 weeks.
    I had crazy high BP, I’m normally corpse low so it was wild seeing those numbers, and some swelling. But as a still exercising and on my feet kindergarten teacher thought nothing of the swelling.
    Having weekly urine tests and blood tests once my BP skyrocketed let my midwives catch it the minute my liver started to conk out.
    I refrained from googling HELLP whilst strapped to my magnesium drip and am glad I didn’t know that 25% stat. We managed a lovely (terrifying) vaginal delivery and despite some severe blood loss everything was good.

    Pre-e gets all the attention, but it’s important for mamas to know about these symptoms too.

  • My water broke a month early and I had to be put under for an emergency c-section, which I was later told was because of HELLP. I spent 3 days in the icu and 10 days in the hospital because my liver and kidneys were not functioning. My blood pressure was never high and the week before I felt like I had the flu. I visited my OB the day my water broke and no one seemed too concerned. Ladies, bottom line, if you think something is wrong, insist on being checked. Thankfully me and my little boy are okay, but some women aren’t so lucky.

  • This is the best, most easily understood article on HELLP I have seen. Thank You! I was diagnosed with HELLP at 27 weeks and had an emergency C 2 days later. Thankfully Mommy and Baby are both fine. Scary shit is right! I (thankfully) didn’t know how dangerous it was until after delivery. My only symptom was pain in my upper right belly, my liver. I had told 2 different doctors and a nurse call center about the pain and they brushed me off as heartburn. Delayed my diagnosis about a week, I ‘m extremely lucky to be okay. I don’t think Doctors know about HELLP either! Articles like this will save lives. Ladies, trust your instincts. I knew heartburn wasn’t supposed to hurt that bad. A blood test was all it took to show what was really wrong. Thank you again. Happy Healthy Babies <3

  • I also had HELLP and both my son and I almost died. (Not exaggerating at all) I had no symptoms what so ever or so I thought. Looking back maybe I might have had one not on the list. I had a tiny little scratch that took forever to stop bleeding. But I didn’t think much of it since pregnant women have so much more blood pumping through there system. Otherwise nothing. Be safe, and don’t wait if something doesn’t feel right.

  • I am also a HELLP survivor. I had a lot of swelling, that was deemed normal. My main symptom was pain under my rib/diaphragm area. It felt like bad gas, but it didn’t go away. I developed liver hematomas that ruptured and I was bleeding internally. I had an emergency c-section at 38 weeks. They had to repair my liver during surgery, I was in the ICU for 4 days. Fortunately, my baby was ok and I was able to recover. Had I waited any longer we both might not have made it. Please if anything feels wrong ask about it, go get checked, be that pregnant lady who sees the doctor for bad gas. It’s better to be safe than sorry.

  • I am a HELLP survivor but unfortunately I lost my son at 27 weeks due to HELLP and possibly marginal insertion of the umbilical cord on the placenta. I had zero obvious symptoms. Just two weeks before I went to the hospital I had visited my OBGYN and had no protein in my urine and my BP was awesome. The reason I went in was because I had realized I hadn’t felt the baby move in a few days and couldn’t find his heart beat with a home doppler. My husband was the one the encouraged me to go to the hospital for peace of mind and we are lucky that he did. While it is tragic and I am sad every day that we lost our son, the outcome could have been worse. Looking back my only symptoms were my swollen feet were not going down at night whereas they did before and my DR was not concerned about the swelling on its own since my BP was fine. I also had a pain in my back between my shoulders which I attributed to having to sleep on my side and having bad posture at work where I sit all day. It just felt like sore muscles and nothing else. All I can suggest is pay very close attention to your body and if something feels even a little off do not ignore it. Don’t worry about being a bother or hypochondriac. Its better to be safe and know for sure.

    • Cortney, I keep coming back to your post. I am so, so sorry for your loss. I am also a HELLP survivor. It really is scary stuff. My baby’s neighbor in the NICU lost her mom to HELLP during childbirth. You are absolutely right that your situation could have been worse. Your husband is fortunate to have you here. It is absolutely better to be safe and know for sure. Thank you for sharing your story.

  • What is the difference in symptoms between this and choleostasis? I know they’re both liver related, but that’s about it.

    • Yup, you’re right, they are both related to the liver. My understanding of choleostasis is that it happens when the liver is blocked so bile actually starts to overflow into the bloodstream and the primary symptom is itchy hands and feet. So, unlike HELLP, choleostasis patients don’t have issues with platelets or blood pressure. I think we’ll add choleostasis to our Scary Shit list as a future post! Thanks!

  • HELLP survivor here! The only symptom I had was elevated blood pressure, and that was only when laying on my side. When laying on my back, it was normal. Thank God for the doctor who decided to have me change positions and check it again, otherwise we never would’ve known about it. She said that with my bloodwork numbers, I should have had kidney pain, a bad headache and more but I felt completely normal. I had an emergency C-section and we’re both fine. I had never even heard of HELLP before that and I never had pre-eclampsia, so it was very shocking and scary!

  • At 30w pregnant with twins, I was diagnosed with both PE and HELLP. I was a mess, and my DH was across an ocean at the time. Amazingly, they managed to stabilize me for another 2.5 weeks before they had to pull the plug, as my liver and only kidney (having had one removed years earlier) were failing. My twins were 3lb5oz each and feisty as alley cats, and only spent a month in the NICU in order to grow. It was an extraordinary time, and I was literally living from blood test to blood test. I urge anyone who is at risk (or even if you aren’t) to check your BP and keep an eye out for any symptoms.

  • I just wanted to note that there have been some links found between having Celiac Disease (usually undiagnosed or only appearing during pregnancy) and HELPP.

  • Thank you for writing about this. I am a HELLP syndrome survivor, but barely. It almost killed me, and only my doctor and his partner caught it and saved my life. There are Promise Walks to raise money and awareness for preeclampsia and HELLP around the country. There is also a documentary coming out sometime next year called Under Pressure- search it on Facebook!

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