A spectrum of liver diseases can affect women both during pregnancy and following delivery. Four pregnancy-specific liver diseases include:

1. Intrahepatic cholestasis of pregnancy (ICP)
2. Acute fatty liver disease of pregnancy (AFLDP)
3. Haemolysis elevated liver enzymes low platelets (HELLP) syndrome
4. Hyperemesis gravidarum (HG)

Haemolysis, elevated liver enzymes, low platelets (HELLP) or HELLP syndrome describes a multi-symptomatic liver disease of pregnancy characterised by the breakdown of red blood cells (haemolysis), elevated liver enzymes and low blood-clotting cells or platelets. It is deemed to be a type of pre-eclampsia (high blood pressure and high concentration of protein in urine).

Typical symptoms

Symptoms, generally appearing in the latter stages of pregnancy and a short while after birth, include fatigue, blurred vision, headache, limb swelling (oedema), bleeding, excessive bruising and abdominal pain.

Diagnosis

HELLP is diagnosed by blood tests, particularly full blood count (FBC) and liver function tests (LFT) which will demonstrate low platelet and red blood cell concentrations, anaemia and elevated liver enzymes. A urine test will reveal elevated protein.

Incidence

This complication of pregnancy occurs in approximately 0.5 to 7.6 cases per 1000 deliveries and can occur in up to one in four cases of pre-eclampsia.

Treatment

Treatment and management include antihypertensive medication, blood transfusions and courses of steroids, with strict monitoring or supervision. Generally, the syndrome resolves once the baby is born, but an early birth might be advised.

Prognosis

In general, mother and baby are not affected long-term following birth. As the condition is dependant on the presence of the placenta (afterbirth), delivery is described as the only cure. HELLP might, however, occur in subsequent pregnancies so medical supervision and advice is vital.