Hellp syndrome: clinical markers of early detection and obstetric management

HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) represents a severe variant of hypertensive disorders of pregnancy and is considered a life-threatening complication of preeclampsia. It is characterized by microangiopathic hemolytic anemia, elevated liver enzymes, and thrombocytopenia. The incidence of HELLP syndrome ranges from 0.5% to 0.9% of all pregnancies and up to 10–20% among women with severe preeclampsia. Early diagnosis remains challenging due to heterogeneous clinical presentation and possible atypical cases without significant hypertension or proteinuria. This article analyzes contemporary approaches to early detection of HELLP syndrome based on clinical, laboratory, and instrumental markers. Particular attention is paid to thrombocytopenia as an early predictor, increased serum levels of AST, ALT, and LDH, markers of hemolysis (bilirubin, haptoglobin, schistocytes), and the prognostic role of angiogenic imbalance markers (sFlt-1/PlGF ratio) in predicting progression from preeclampsia to HELLP syndrome. Differential diagnosis with acute fatty liver of pregnancy, thrombotic thrombocytopenic purpura, and hemolytic uremic syndrome is discussed. Modern obstetric management strategies depending on gestational age and severity of maternal and fetal condition are outlined. Delivery remains the only definitive treatment; however, in pregnancies under 34 weeks of gestation, short-term expectant management may be considered under strict maternal and fetal monitoring. Key aspects of intensive care include blood pressure control, seizure prophylaxis with magnesium sulfate, correction of coagulopathy, and management of thrombocytopenia.