HELLP syndrome is a complication of pregnancy; the acronym stands for hemolysis, elevated liver enzymes, and low platelet count. It usually begins during the last three months of pregnancy or shortly after childbirth. Symptoms may include feeling tired, retaining fluid, headache, nausea, upper right abdominal pain, blurry vision, nosebleeds, and seizures. Complications may include disseminated intravascular coagulation, placental abruption, and kidney failure. The cause is unknown. The condition occurs in association with pre-eclampsia or eclampsia. Other risk factors include previously having the syndrome and a mother older than 25 years. The underlying mechanism may involve abnormal placental development. Diagnosis is generally based on blood tests finding signs of red blood cell breakdown (lactate dehydrogenase greater than 600 U/L), an aspartate transaminase greater than 70 U/L, and platelets less than 100×109/l. If not all the criteria are present, the condition is incomplete. Treatment generally involves delivery of the baby as soon as possible. This is particularly true if the pregnancy is beyond 34 weeks of gestation. Medications may be used to decrease blood pressure and blood transfusions may be required. HELLP syndrome occurs in about 0.7% of pregnancies and affects about 15% of women with eclampsia or severe pre-eclampsia. Death of the mother is uncommon (< 1%). Outcomes in the babies are generally related to how premature they are at birth. The syndrome was first named in 1982 by American gynaecologist Louis Weinstein. Signs and symptoms The first signs of HELLP usually start appearing midway through the third trimester, though the signs can appear in earlier and later stages. It is highly associated with known pre-eclampsia. Risk factors for pre-eclampsia include older age, uncontrolled hypertension, diabetes mellitus, and obesity. Symptoms for HELLP vary in severity and between individuals and are commonly mistaken with normal pregnancy symptoms, especially if they are not severe. HELLP syndrome patients experience general discomfort followed by severe epigastric pain or right upper abdominal quadrant pain, accompanied by nausea, vomiting, backache, anaemia, and hypertension. Some patients may also have a headache and visual issues. These symptoms may also become more severe at night. As the condition progresses and worsens, a spontaneous hematoma occurs following the rupture of the liver capsule, which occurs more frequently in the right lobe. The presence of any combinations of these symptoms, subcapsular liver hematoma in particular, warrants an immediate check-up due to the high morbidity and mortality rates of this condition. Risk factors