HELLP Syndrome Diagnostic Criteria
Mississippi classification for HELLP syndrome (Haemolysis, Elevated Liver enzymes, Low Platelets). Class I most severe.
Score interpretation
Criteria not met for HELLP syndrome. Consider alternative diagnoses if symptomatic.
→ If pre-eclampsia features present, manage per NICE NG133. Consider TTP, HUS, acute fatty liver of pregnancy if haemolysis present without hypertension.
Partial or Class III HELLP: platelets 100–150, some haemolysis or elevated enzymes.
→ Admit to obstetric HDU. IV access × 2. Bloods: FBC, LFTs, LDH, clotting, urate, U&E every 6–12h. Antihypertensives if BP ≥ 150/100. Corticosteroids for fetal lung maturity if < 34 weeks. Consider delivery plan.
HELLP syndrome confirmed. Class I (platelets < 50) or Class II (platelets 50–99) — high maternal risk.
→ IMMEDIATE delivery if ≥ 34 weeks or maternal/fetal compromise. MgSO₄ for seizure prophylaxis (4g IV bolus then 1g/h). Antihypertensives: IV labetalol or hydralazine for SBP ≥ 160. Blood bank: crossmatch 4 units. Platelet transfusion if < 20 or < 50 pre-CS. ICU involvement. Neonatology present at delivery.
Interpretation bands for the HELLP. Apply clinical judgement and local guidance.
References
- Martin JN Jr et al. The spectrum of severe preeclampsia: comparative analysis by HELLP syndrome classification. Am J Obstet Gynecol. 1999.
- NICE NG133. Hypertension in pregnancy: diagnosis and management. 2019.
Related
Curated clinical cross-links plus same-class fallbacks.
- Labetalol (IV — Hypertensive Emergency) · Combined Alpha-1 and Beta-Adrenergic Blocker
- Labetalol (IV — Hypertensive Emergency) · Combined alpha and beta blocker
- Magnesium Sulphate (Obstetric — Eclampsia/Neuroprotection) · Anticonvulsant / Neuroprotectant
- Hydralazine · Direct-Acting Vasodilator — Hypertensive Emergency / Chronic Hypertension
- Sodium Nitroprusside · Direct Vasodilator (NO Donor) — Hypertensive Emergency / Aortic Dissection
- Tenecteplase · Cardiovascular Emergency
- Spinal Anaesthesia Hypotension Management · AAGBI; ASA
- Pre-Eclampsia / Eclampsia in ED · NICE NG133; RCOG Green-top 10A
- Suspected Ectopic Pregnancy · NICE NG126; RCOG Green-top 21
- Polycystic Ovary Syndrome (PCOS) · International PCOS Guideline 2023; NICE CKS
- Pre-eclampsia Management · NICE NG133 2019
- Ectopic Pregnancy · NICE CG154 / RCOG GTG 21
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.