HELLP Syndrome Questions & Answers

1. Rahman TM, Wendon J. Severe hepatic dysfunction in pregnancy. Q J Med. 2002. 95:343:[QxMD MEDLINE Link].

2. Lichtman, M, Kipps T, Seligsohn U, Kaushansky K, Prchal J. Hemolytic Anemia resulting from physical Injury to Red Cells. Williams Hematology, Eighth Edition. 8. McGraw-Hill Companies; 2010. Chapter 50.

3. Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: A severe consequence of hypertension in pregnancy. Am J Obstet Gynecol. 1982. 142:159. [QxMD MEDLINE Link].

4. Lichtman, M, Kipps T, Seligsohn U, Kaushansky K, Prchal J. Thrombocytopenia. Williams Hematology, Eighth Edition. 8. McGraw-Hill Companies; 2010. Chapter 119.

5. Knerr I, Beinder E, Rascher W. Syncytin, a novel human endogenous retroviral gene in human placenta: Evidence for its dysregulation in preeclampsia and HELLP syndrome. Am J Obstet Gynecol. 2002. 186:210. [QxMD MEDLINE Link].

6. Levine RJ, Maynard SE, Qian C, et al. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med. 2004. 350:672. [QxMD MEDLINE Link].

7. Mutter WP, Karumanchi SA. Molecular mechanisms of preeclampsia. Microvasc Res. 2008. 75:1. [QxMD MEDLINE Link].

8. Widmer M, Villar J, Beniani A, et al. Mapping the theories of preeclampsia and the role of angiogenic factors: A systematic review. Obstet Gynecol 109:168, 2007. Obstet Gynecol. 2007. 109:168. [QxMD MEDLINE Link].

9. Semenovskaya Z, Erogul M. Pregnancy, Preeclampsia. Medscape Reference. May 2010. [Full Text].

10. Weiner E, Schreiber L, Grinstein E, Feldstein O, Rymer-Haskel N, Bar J, et al. The placental component and obstetric outcome in severe preeclampsia with and without HELLP syndrome. Placenta. 2016 Nov. 47:99-104. [QxMD MEDLINE Link].

11. Stojanovska V, Zenclussen AC. Innate and adaptive immune responses in HELLP syndrome. Front Immunol. 2020. 11:667. [QxMD MEDLINE Link]. [Full Text].

12. Zhou Y, McMaster M, Woo K, et al. Vascular endothelial growth factor ligands and receptors that regulate human cytotrophoblast survival are dysregulated in severe preeclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome. Am J Pathol. 2002. 160:1405-23. [QxMD MEDLINE Link].

13. Nelson J, Lewis B, Walters B. The HELLP syndrome associated with fetal medium chain acyl-CoA dehydrogenase deficiency. Journal of Inherited Metabolic Diseases. 2000. 23:518-519.

14. Ibdah JA, Bennet MJ, Rinaldo P, Zhao Y, Gibson B, Sims HF, et al. A fetal fatty-acid oxidation disorder as a cause of liver disease in pregnant women. New England Journal of Medicine. 1999. 340:1723-1731.

15. Strand S, Strand D et al. Placenta-derived CD59 ligand causes liver damage in hemolysis, elevated liver enzymes and low platelet count syndrome. Gastroenterology. 2004. 126:849-858.

16. Fang C, Richards A et al. Advances in understanding of pathogenesis of aHUS and HELLP. BJH British Journal of Haematology. 2008. 143:336-348.

17. Ohara Padden, M. HELLP Syndrome: Recognition and Perinatal Management. The Academy of Family Physicians. Sept 1, 1999. [Full Text].

18. Martin JN Jr, Magann EF, Blake PG. Analysis of 454 pregnancies with severe preeclampsia/eclampsia/HELLP syndrome using the 3-class system of classification. Am J Obstret Gynecol 1993. 1993. 168:386.

19. Martin JN Jr, Magann EF. HELLP syndrome current principles and recommended practice. Curr Obstet Med. 1996. 4:129-75.

20. Sibai BM, Ramamdan MK, Usta I, Salama M, Mercer BM, Friedman SA. Maternal morbidity and mortality in 442 pregnancies with HELLP syndrome. Am J Obstet Gynecol. 1993. 169:1000-6.

21. Ukomadu C, Greenberger N, Blumberg R, Burakoff R. Hepatic Complications of Pregnancy. Current Diagnosis and Treatment: Gastroenterology, Hepatology and Endoscopy. McGraw Hills and Company; 2009. Chapter 8.

22. O’Brien JM, Barton JR. Controversies with the diagnosis and management of HELLP syndrome. Clinical Obstetrics and Gynecology. June 2005. 48:2:460-477.

23. Sullivan CA, Magann EF, Perry KG Jr, et al. The recurrence risk of the syndrome of hemolysis, elevated liver enzymes, and low platelets: Subsequent pregnancy outcome and long term prognosis. Am J Obstet Gynecol. 1995. 172:125.

24. Barton JR, Sibai BM. Diagnosis and management of hemolysis, elevated liver enzymes, and low platelets syndrome. Clin Perinatol. 2004. 31:807-33. [QxMD MEDLINE Link].

25. Magann EF, Martin JN Jr. Twelve steps to optimal management of HELLP syndrome. Clin Obstet Gynecol. 1999. 42:532. [QxMD MEDLINE Link].

26. Isler CM, Rinehart CK, Terrone DA, Martin RW, Magann EF, Martin JN Jr. Maternal mortality associated with HELLP syndrome. Am J Obstet Gynecol. 1999. 181:924-8.

27. Rath W, Faridi A, Dudenhausen JW. HELLP syndrome. J Perinat Med. 2000. 28:249. [QxMD MEDLINE Link].

28. Harms K, Rath W, Herting E, Kuhn W. Maternal hemolysis, elevated liver enzymes, low platelet count, and neonatal outcome. Am J Perinatol. 1995. 12:1:[QxMD MEDLINE Link].

29. Messina V, Dondossola D, Paleari MC, et al. Liver bleeding due to HELLP syndrome treated with embolization and liver transplantation: a case report and review of the literature. Front Surg. 2021. 8:774702. [QxMD MEDLINE Link]. [Full Text].

30. Sibai BM. Diagnosis, controversies and management of the syndrome of hemolysis, elevated liver enzymes and low platelet count. Obstet and Gynecol. 2004. 103:981-91.

31. Vigil-De Gracia P. Pregnancy complicated by pre-eclampsia-eclampsia with HELLP syndrome. Int J Gynecol Obstet. 2001. 72:17-23.

32. Martin JN Jr. Rinehart K, May WL, Magann EF, Terrone DA, Blake PG. The spectrum of severe preeclampsia: comparative analysis by HELLP syndrome classification. Am J Obstet Gynecol. 1999. 180:1373-84.

33. Sibai B. HELLP Syndrome. UptoDate. 2010. [Full Text].

34. Weinstein L. Preeclampsia/eclampsia with hemolysis, elevated liver enzymes and thrombocytopenia. Obstet Gynecol. 1985. 66:657- 60.

35. Roberts JM. Cooper DW. Pathogenesis and genetics of pre-eclampsia. Lancet. 2001. 357:53-56.

36. Aarnoudse JG, Houthhoff HF et al. A syndrome of liver damage and intravascular coagulation in the last trimester of normotensive pregnancy. A clinical and histopathological study. BR J Obstet Gynaecol. 1986. 93:145-155.

37. Arias F, Mancilla-Jimenez R. Hepatic fibrinogen deposits in pre-eclampsia. Immunofluorescent evidence. N Engl J Med. 1976. 295:578-582.

38. Barton JR, Riely CA, Adamel TA, et al. Hepatic histopathologic condition does not correlate with laboratory abnormalities in HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count). Am J Obstet Gynecol. 1992. 167:1538-1543.

39. Barton JR, Sibai BM. Hepatic imaging in HELLP syndrome. Am J Obstet Gynecol. 1996. 174:1820-1827.

40. Martin JN Jr., Magann EF, Isler CM. HELLP Syndrome: the scope of disease and treatment. HELLP Syndrome: the scope of disease and treatment. Belfort MA. Thornton S, Saade GR. Hypertension in Pregnancy. Oxford:Marcel Dekker; 2003. Chapter 7 p 141-88.

41. Martin JN Jr. Rose C, Briery C. Understanding and managing HELLP syndrome: The integral role of aggressive glucocorticoids for mother and child. Am J of Obst & Gyn. 2006. 195:914-34.

42. Van Runnard Heimel PH, Juisjes AJM, Franx A, Koopman C, Bots ML, Bruinse HW. A randomized placebo-controlled trial of prolonged administration to patients with HELLP syndrome remote from term: maternal and neonatal complications. Am J Obstet Gynecol. 2004. 191:S41.

43. Isler CM, Barrilleaux PS, Magann EF et al. A prospective randomized trial comparing the efficacy of dexamethasone and betamethasone for the treatment of antepartum HELLP syndrome. Am J Obstet Gynecol. 2001. 184:1332-39.

44. O’Brien JM, Milligan DA, Barton JR. Impact of high-dose corticosteroid therapy for patients with HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome. Am J Obstet Gynecol. 2000. 183:921-4.

45. Briggs R, Chari RS, Mercer B, Sibai BM. Postoperative incision complications after cesareansection in patients with antepartum syndrome of hemolysis, elevated liver enzymes, and lowplatelets (HELLP): does delayed primary closure make a difference?. Am J Obstet Gynecol. 1996. 175:183-6.

Huma Khan, MD Resident Physician, Department of Emergency Medicine, Northshore-Long Island Jewish Medical Center

Disclosure: Nothing to disclose.

Natalie B Meirowitz, MD Assistant Professor of Obstetrics and Gynecology, Albert Einstein College of Medicine; Chief of Maternal-Fetal Medicine, Director, Center for Maternal-Fetal Health, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northshore-Long Island Jewish Medical Center

Natalie B Meirowitz, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ronald M Ramus, MD Professor of Obstetrics and Gynecology, Director, Division of Maternal-Fetal Medicine, Virginia Commonwealth University School of Medicine

Ronald M Ramus, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, Medical Society of Virginia, Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Jordan G Pritzker, MD, MBA, FACOG Adjunct Professor of Obstetrics/Gynecology, Hofstra North Shore-LIJ School of Medicine at Hofstra University; Attending Physician, Department of Obstetrics and Gynecology, Long Island Jewish Medical Center; Medical Director, Aetna, Inc; Private Practice in Gynecology

Disclosure: Nothing to disclose.

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