HELLP Syndrome — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Immediate delivery needed?
   Gestational age and maternal-fetal status — is immediate delivery needed? (Hemolysis + raised liver enzymes + low platelets in pregnancy/postpartum, a severe pre-eclampsia variant; ~70% antepartum (mostly 27–37 weeks), the rest within 48 h postpartum. Tennessee (complete, all three): 1) hemolysis (schistocytes/LDH >600/bilirubin >1.2/haptoglobin <25); 2) AST (or ALT) ≥70 (>2× ULN); 3) platelets <100×10⁹. Mississippi grades by platelet nadir (class 1 <50k is most severe, with liver-rupture risk). RUQ/epigastric pain + nausea, may have no hypertension/proteinuria; complications DIC/abruption/subcapsular liver hematoma rupture/AKI.)
   • ≥34 weeks or maternal/fetal deterioration / severe complication → Deliver → terminate pregnancy
   • <34 weeks, maternal-fetal stable → <34 weeks stable · stabilize + steroids
2. [End] <34 weeks stable · stabilize + steroids
   <34 weeks, maternal-fetal stable (no DIC/abruption/liver rupture/fetal distress/uncontrolled severe hypertension): stabilize the mother — control BP (labetalol/hydralazine/nifedipine) + magnesium sulfate for seizure prophylaxis + correct DIC/transfuse as needed; a single course of betamethasone for fetal lung maturity; brief expectant management for 24–48 h to gain the steroid window, with close monitoring of mother, fetus and platelets/liver enzymes/subcapsular hematoma (liver US). Deliver the moment it worsens.
3. [End] Deliver → terminate pregnancy
   ≥34 weeks or maternal/fetal deterioration / severe complication (DIC, abruption, liver rupture, renal failure, pulmonary edema, eclampsia, fetal distress): delivery is definitive — deliver promptly; control BP + magnesium (continue 24 h postpartum) + correct DIC/transfuse (platelets/plasma as needed); vaginal delivery preferred (if no contraindication); beware subcapsular liver hematoma rupture (surgical emergency); postpartum HELLP can worsen — monitor platelet/liver-enzyme trends closely.

Source guidelines & references

• HELLP syndrome (ACOG; Tennessee/Mississippi criteria)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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