Definition and research guide
This page combines a MeSH definition, publication statistics and selected research abstracts. It is a starting point for reading the literature, not a medical textbook or a systematic evidence review.
Content available: 4 complete abstracts (829 words), 10 references. Full article text is not stored or reproduced here; follow the PMID, DOI or PMC links to read the original sources and their access terms.
Definition
A syndrome of hemolysis, elevated liver enzymes, and low blood platelets count (thrombocytopenia). hellp syndrome is observed in pregnant people with pre-eclampsia or eclampsia who also exhibit liver damage and abnormalities in blood coagulation.
Definition: NLM Medical Subject Headings (MeSH) scope note (Public domain (U.S. National Library of Medicine); attribution requested). View the MeSH record.
Also known as: Syndrome, HELLP; Hemolysis, Elevated Liver Enzymes, Lowered Platelets.
Where it fits in the MeSH classification
- Broader topics
- Hypertension, Pregnancy-Induced
Related concepts
- Hemolysis
- Enzymes
- Thrombocytopenia
- Hellp
- Pregnant People
- Pre-Eclampsia
- Eclampsia
- Liver
- Blood Coagulation
Research landscape
PubMed indexes 2,106 records tagged with the MeSH heading “HELLP Syndrome” (counts retrieved 2026-11-04). 315 of them (15.0%) were published from 2020 onward, and the busiest period so far is 2000-2009 with 776 records.
Reviews account for 386 records (18.3%) and meta-analyses for 18. Randomized controlled trials number 31 (1.5%) as a share of all records on the topic. Randomized trials make up only a small share of this literature, so much of what is known comes from laboratory, observational or descriptive work.
Show the data
| Period | Records |
|---|---|
| through 1999 | 407 |
| 2000-2009 | 776 |
| 2010-2019 | 608 |
| 2020 onward | 315 |
Publication-type chart data
| Type | Records | Share |
|---|---|---|
| Reviews | 386 | 18.3% |
| Meta-analyses | 18 | 0.9% |
| Randomized controlled trials | 31 | 1.5% |
Method: PubMed query "HELLP Syndrome"[MeSH Terms] with publication-type and date filters, retrieved 2026-11-04.
Reading the evidence in kidney, urology and women's health
Kidney, urinary and reproductive health research uses lab markers (such as creatinine), imaging, symptom scores and registry data on pregnancy and birth. Findings about pregnancy are especially sensitive to who was studied and when in pregnancy exposure occurred. Nothing on this page is advice about treatment, fertility or pregnancy; speak to a qualified clinician. Check the population, the outcome measured and whether the study accounted for other health differences between groups.
Evidence from open-access studies
These open-access studies come from PubMed’s best-match results for this heading (papers whose main topic it is), ranked here by citation count, with one recent addition. Each abstract is reproduced in full under its recorded open licence so that you can read the authors’ own words. They illustrate the literature; they are not a systematic summary of it. Citation counts measure attention, not reliability or clinical benefit.
| Study / authors | Year | Source label / design | Europe PMC citations | Licence / source |
|---|---|---|---|---|
| The HELLP syndrome: clinical issues and management. A Review | 2009 | Review article Design not recorded in structured metadata | 341 | cc by PMID 19245695 · DOI · PMC2654858 |
| Genetic aspects of preeclampsia and the HELLP syndrome | 2014 | Review article Design not recorded in structured metadata | 56 | cc by PMID 24991435 · DOI · PMC4060423 |
| HELLP Syndrome-Holistic Insight into Pathophysiology | 2022 | Review article Design not recorded in structured metadata | 39 | cc by PMID 35208649 · DOI · PMC8875732 |
| Prediction of neonatal outcomes using gestational age vs ACOG definitions of maternal disease severity in hypertensive disorders of pregnancy | 2025 | Research article Design not recorded in structured metadata | 2 | cc by PMID 39152282 · DOI · PMC11920366 |
The HELLP syndrome: clinical issues and management. A Review [1]
Abstract reading summary — source excerpts
- Opening excerpt
- BackgroundThe HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.
- Closing excerpt
- Close surveillance of the mother should be continued for at least 48 hours after delivery.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (295 words)
BackgroundThe HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10-20% of cases with severe preeclampsia. The present review highlights occurrence, diagnosis, complications, surveillance, corticosteroid treatment, mode of delivery and risk of recurrence.MethodsClinical reports and reviews published between 2000 and 2008 were screened using Pub Med and Cochrane databases.Results and conclusionAbout 70% of the cases develop before delivery, the majority between the 27th and 37th gestational weeks; the remainder within 48 hours after delivery. The HELLP syndrome may be complete or incomplete. In the Tennessee Classification System diagnostic criteria for HELLP are haemolysis with increased LDH (> 600 U/L), AST (>or= 70 U/L), and platelets or= 48 hours) is controversial but may be considered in selected cases < 34 weeks' gestation. Delivery is indicated if the HELLP syndrome occurs after the 34th gestational week or the foetal and/or maternal conditions deteriorate. Vaginal delivery is preferable. If the cervix is unfavourable, it is reasonable to induce cervical ripening and then labour. In gestational ages between 24 and 34 weeks most authors prefer a single course of corticosteroid therapy for foetal lung maturation, either 2 doses of 12 mg betamethasone 24 hours apart or 6 mg or dexamethasone 12 hours apart before delivery. Standard corticosteroid treatment is, however, of uncertain clinical value in the maternal HELLP syndrome. High-dose treatment and repeated doses should be avoided for fear of long-term adverse effects on the foetal brain. Before 34 weeks' gestation, delivery should be performed if the maternal condition worsens or signs of intrauterine foetal distress occur. Blood pressure should be kept below 155/105 mmHg. Close surveillance of the mother should be continued for at least 48 hours after delivery.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 19245695 · DOI · PMC2654858
Genetic aspects of preeclampsia and the HELLP syndrome [2]
Abstract reading summary — source excerpts
- Opening excerpt
- Both preeclampsia and the HELLP syndrome have their origin in the placenta.
- Closing excerpt
- Preeclampsia and the HELLP syndrome are multiplex genetic diseases.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (209 words)
Both preeclampsia and the HELLP syndrome have their origin in the placenta. The aim of this study is to review genetic factors involved in development of preeclampsia and the HELLP syndrome using literature search in PubMed. A familial cohort links chromosomes 2q, 5q, and 13q to preeclampsia. The chromosome 12q is coupled with the HELLP syndrome. The STOX1 gene, the ERAP1 and 2 genes, the syncytin envelope gene, and the -670 Fas receptor polymorphisms are involved in the development of preeclampsia. The ACVR2A gene on chromosome 2q22 is also implicated. The toll-like receptor-4 (TLR-4) and factor V Leiden mutation participate both in development of preeclampsia and the HELLP syndrome. Carriers of the TT and the CC genotype of the MTHFR C677T polymorphism seem to have an increased risk of the HELLP syndrome. The placental levels of VEGF mRNA are reduced both in women with preeclampsia and in women with the HELLP syndrome. The BclI polymorphism is engaged in development of the HELLP syndrome but not in development of severe preeclampsia. The ACE I/D polymorphism affects uteroplacental and umbilical artery blood flows in women with preeclampsia. In women with preeclampsia and the HELLP syndrome several genes in the placenta are deregulated. Preeclampsia and the HELLP syndrome are multiplex genetic diseases.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 24991435 · DOI · PMC4060423
HELLP Syndrome-Holistic Insight into Pathophysiology [3]
Abstract reading summary — source excerpts
- Opening excerpt
- HELLP syndrome, also known as the syndrome of hemolysis, elevated liver enzymes, and low platelets, represents a severe pregnancy complication typically associated with hypertension.
- Closing excerpt
- A better knowledge of the disease's course supports early detection, an accurate diagnosis, and proper management of this life-threatening condition.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (153 words)
HELLP syndrome, also known as the syndrome of hemolysis, elevated liver enzymes, and low platelets, represents a severe pregnancy complication typically associated with hypertension. It is associated with increased risks of adverse complications for both mother and fetus. HELLP occurs in 0.2-0.8% of pregnancies, and, in 70-80% of cases, it coexists with preeclampsia (PE). Both of these conditions show a familial tendency. A woman with a history of HELLP pregnancy is at high risk for developing this entity in subsequent pregnancies. We cannot nominate a single worldwide genetic cause for the increased risk of HELLP. Combinations of multiple gene variants, each with a moderate risk, with concurrent maternal and environmental factors are thought to be the etiological mechanisms. This review highlights the significant role of understanding the underlying pathophysiological mechanism of HELLP syndrome. A better knowledge of the disease's course supports early detection, an accurate diagnosis, and proper management of this life-threatening condition.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 35208649 · DOI · PMC8875732
Prediction of neonatal outcomes using gestational age vs ACOG definitions of maternal disease severity in hypertensive disorders of pregnancy [4]
Abstract reading summary — source excerpts
- Opening excerpt
- PurposeHypertensive disorders of pregnancy cause significant neonatal complications.
- Closing excerpt
- This observation underscores the need for further research to validate these findings in larger cohorts and to determine their applicability to maternal outcomes.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (172 words)
PurposeHypertensive disorders of pregnancy cause significant neonatal complications. Disease severity is often used to predict neonatal outcomes, however gestational age (GA) at delivery may be a better predictor. We aimed to assess whether disease severity or GA was more predictive of adverse neonatal outcomes.MethodsWe included 165 participants with confirmed HELLP syndrome or severe preeclampsia (sPE). Two predictive models were constructed to assess the ability of disease severity compared to GA to predict a composite adverse neonatal outcome. The composite outcome included low birth weight, SGA, IUGR, Apgar score, and neonatal death.ResultsUsing severity as a predictor of binary neonatal outcome had an AUC of 0.73 (0.65-0.81), with a sensitivity (SE) of 70.3% and a specificity (SP) of 64.4%. For GA, we observed an AUC of 0.82 (0.75-0.89), with a SE of 75.7% and a SP of 76.7%.ConclusionFor the composite neonatal outcome, GA was a better predictor than ACOG diagnosis (severity). This observation underscores the need for further research to validate these findings in larger cohorts and to determine their applicability to maternal outcomes.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 39152282 · DOI · PMC11920366
Key reviews and meta-analyses
The most cited review-type papers among PubMed’s best-match results for this heading, listed with bibliographic details only. Follow the links for the full text and access terms.
- Research article Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count [5]
- Research article Evaluation and management of severe preeclampsia before 34 weeks' gestation [6]
- Research article Pathogenesis of the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP): a review [7]
- Research article Understanding and managing HELLP syndrome: the integral role of aggressive glucocorticoids for mother and child [8]
- Research article Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis [9]
- Research article Imitators of severe preeclampsia [10]
References
- Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: clinical issues and management. A Review. . 2009. PMID 19245695 · DOI · PMC2654858
- Haram K, Mortensen JH, Nagy B. Genetic aspects of preeclampsia and the HELLP syndrome. . 2014. PMID 24991435 · DOI · PMC4060423
- Petca A, Miron BC, Pacu I, Dumitrașcu MC, Mehedințu C, Șandru F, et al.. HELLP Syndrome-Holistic Insight into Pathophysiology. . 2022. PMID 35208649 · DOI · PMC8875732
- Hauptman I, Gill KS, Lim T, Mack WJ, Wilson ML. Prediction of neonatal outcomes using gestational age vs ACOG definitions of maternal disease severity in hypertensive disorders of pregnancy. . 2025. PMID 39152282 · DOI · PMC11920366
- Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 2004. PMID 15121574 · DOI
- Publications Committee, Society for Maternal-Fetal Medicine, Sibai BM. Evaluation and management of severe preeclampsia before 34 weeks' gestation. Am J Obstet Gynecol. 2011. PMID 22071049 · DOI
- Abildgaard U, Heimdal K. Pathogenesis of the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP): a review. Eur J Obstet Gynecol Reprod Biol. 2013. PMID 23107053 · DOI
- Martin JN, Rose CH, Briery CM. Understanding and managing HELLP syndrome: the integral role of aggressive glucocorticoids for mother and child. Am J Obstet Gynecol. 2006. PMID 16631593 · DOI
- van Oostwaard MF, Langenveld J, Schuit E, Papatsonis DN, Brown MA, Byaruhanga RN, et al.. Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis. Am J Obstet Gynecol. 2015. PMID 25582098 · DOI
- Sibai BM. Imitators of severe preeclampsia. Obstet Gynecol. 2007. PMID 17400860 · DOI
About this article
- Sources
- NLM Medical Subject Headings (definition, synonyms); NCBI PubMed (counts, identifiers); Europe PMC (open-access abstracts and citation counts).
- Verification
- Every reference was resolved against PubMed on 2026-11-04; title, year and DOI matched.
- Review state
- automated source verified; no human expert review has been recorded yet.
- Version
- 1, last updated 2026-11-04.
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Evidence strength
EvidenceHelix's computed view of the study designs behind this topic: how common meta-analyses, randomized trials and reviews are, how recent the literature is, and a plain-language reading. It describes the design mix of the literature. It is not a quality appraisal of any study, and it is not medical advice.