We have detected you are using Internet Explorer. To provide the best and most secure experience, please use a modern browser as we do not support Internet Explorer.

Obstetric Emergencies, can you help Lauren?

11 April 2024 -

You are working in ED and have received a call from Pathology regarding blood results that you took earlier on Lauren, who is 18 years old and 30 weeks pregnant with her first child.

Lauren presented earlier in the day with her partner complaining of “feeling unwell” with upper abdominal pain and a headache. Her blood pressure was 130/90 on admission and is now 145/95. Pathology informs you that Lauren’s LFTs (liver function tests) are high, and her platelets are low. 

What may be causing Lauren’s abnormal blood results?

Lauren’s blood results indicate that she has HELLP syndrome, a life threatening obstetric emergency. 

HELLP syndrome is so named due to the triad of characteristics of the syndrome which are Haemolysis, Elevated Liver enzymes, and Low Platelets, although it may be complete or incomplete (only one or two criteria met).

It is often considered a variant of pre-eclampsia, with similar clinical symptoms. The diagnostic criteria for HELLP is haemolysis, increased LDH (> 600 U/L), increased AST (>or= 70 U/L) and low platelets (< 100 x 10(9)/L).

Complications for the mother include liver or cerebral infarction, abruptio placentae, severe postpartum haemorrhage, subcapsular liver haematoma, intracerebral or brainstem haemorrhage and/ or DIC, with a 1-2% mortality. Risks for the baby include abruptio placentae, preterm delivery, or foetal demise in utero.

HELLP syndrome usually presents in the third trimester but may occur up to  7 days post delivery. Postpartum onset of HELLP has a higher risk of Acute Pulmonary Oedema (APO) and Acute Kidney Injury (AKI).

HELLP syndrome may be difficult to diagnose as the typical signs of pre-eclampsia may not be apparent. Symptoms may include one or more of the following:

  • Epigastric or substernal pain, particularly RUQ
  • Dyspnoea
  • Nausea, vomiting, or indigestion
  • Headache not relieved by paracetamol
  • Shoulder pain or pain with deep inspiration
  • Bleeding
  • Blurred vision, diplopia, seeing flashing lights or auras
  • Oedema particularly face or hands
  • Polyuria

Investigative signs include:

  • Hypertension
  • Proteinuria
  • Elevated LFT’s – bilirubin, AST, ALT, LDH
  • Low platelets
  • Normal PT, APTT and coag screen
  • Haemolysis on blood film

Management and treatment includes:

  • Delivery of the baby if HELLP syndrome occurs after the 34th gestational week or if foetal and/or maternal conditions deteriorate
  • Consider HDU/ ICU admission
  • Antihypertensives - consider invasive monitoring
  • IV MgSO4 IV for eclamptic seizure prophylaxis
  • IV corticosteroids for foetal lung maturity
  • Recognise and treat complications

Related courses

Critical Bytes: Obstetric Emergencies webinar


ACI. (2024). Pre eclampsia and eclampsia.Emergency Care Institute. Date accessed: 10 Apr 2024

LEE, R., AJAY, B.The Unusual Presentation of HELLP Syndrome. Journal of Clinical Gynecology and Obstetrics, North America, 8, dec. 2019. Available at: Date accessed: 10 Apr 2024

Nickson, C. (2020). HELLP Syndrome. Life in the Fast Lane. Date accessed: 10 Apr 2024

Pe-eclampsia Foundation. (2022). Date accessed: 10 Apr 2024

Get Medcast Plus

Become a member and get unlimited access to 100s of hours of premium education.

Learn more
Latest News
Optimising paediatric Eczema Care: A Nurses’ Guide
Brand icon

Explore essential strategies and insights for managing paediatric eczema effectively in this guide. From daily skincare routines to addressing common triggers and mental health considerations, empower families with the knowledge and tools to improve their child's quality of life.

5 mins READ
Men’s health behaviours - Clinical opal

Gender influences individuals’ health behaviours and their use of health services. This translates into a high burden of disease in males due to the contribution of modifiable risk factors. Helping men understand how their behaviour influences their health, and what they can do to change it, may help them to live longer, healthier lives.

5 mins READ
Medcast Partners with the University of Wollongong to Combat Antimicrobial Resistance

Medcast is thrilled to announce a new collaboration with the University of Wollongong’s Graduate School of Medicine. The $2.7M MRFF grant focuses on reducing the inappropriate prescription of antibiotics, a key factor in the development of antimicrobial resistance (AMR).