Childbirth with HELLP syndrome — mode of delivery at Genesis Dnepr Clinic

What is delivery in HELLP syndrome:

it refers to the delivery of a woman with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), which requires intensified monitoring and coordinated work by obstetric, intensive care/resuscitation, and laboratory teams.

This applies to pregnant women who develop signs of HELLP or complicated preeclampsia in late pregnancy.

It is important to discuss in advance with the physician and obstetrician possible delivery scenarios, a monitoring plan for mother and fetus, as well as analgesia/anesthesia and preparations for emergency interventions.

The final decision is made individually based on the clinical picture and test results and may change during labor for the safety of the mother and baby.

What the delivery format means in HELLP syndrome

This refers to delivery in a mother with a complicated condition that requires enhanced monitoring and readiness for rapid clinical decisions. The approach differs from routine deliveries in that the emphasis is on monitoring, laboratory surveillance, and team coordination. Before labor begins it is important to discuss possible scenarios, monitoring, and analgesia/anesthesia issues. The final decision will be made as labor progresses, depending on the condition of the mother and the fetus.

Delivery under enhanced maternal and fetal monitoring with regular reassessment.
A multidisciplinary team: obstetrician, anesthesiologist, and intensivist/resuscitation specialist on standby.
Readiness to proceed to operative delivery if the clinical situation deteriorates.
A monitoring and laboratory testing plan to be discussed before labor begins.
Discussion of analgesia/anesthesia options and possible limitations with the anesthesiologist in advance.
Flexibility of the plan: it may be changed as needed in the interest of the safety of mother and baby.

This approach is not universal and is chosen individually after discussion of the clinical situation. If you have questions about your birth plan, discuss them with the team in advance.

Who this delivery format may be suitable for

This format may be appropriate when a pre-agreed delivery plan and increased attention to the condition of the mother and fetus are required. It is discussed when HELLP syndrome is suspected or confirmed and in other situations where rapid coordination of the care team is important. It's best to talk through details and possible limitations in advance with the maternity team.

A wish to discuss delivery scenarios and potential developments in advance.
Having a partner who is planned to be present during delivery (by arrangement).
Questions about pain relief options that you want to go over before labor.
A desire to know who will be attending the birth and how the team is organized.
A pregnancy without acute contraindications, where a planned approach is possible.
The intention to remain active and participate in the birth process, if allowed.
Taking previous birth experience into account when creating an individualized plan.

The decision on the format is made individually based on examination and the current condition. Discuss your expectations and questions with the maternity team in advance.

When the planned birth format may need to be restricted or changed

Even a previously agreed birth plan can be revised at any time if new medical information emerges or the condition worsens. With HELLP syndrome and related conditions it is especially important to be prepared for an urgent change of plan for the safety of the mother and baby. The team — the obstetrician and midwife together with the anesthesiologist and intensivist — will explain the reasons for and the options for adjustments.

Sudden development of obstetric complications requiring immediate intervention.
Signs of fetal distress on monitoring requiring expedited delivery.
The need for an emergency cesarean section or other operative completion of labour.
A significant drop in platelet count limiting the use of certain methods of anesthesia/pain relief.
Active maternal infection or logistical restrictions preventing the partner’s presence.
Situations in which the mother’s safety takes precedence over maintaining the original birth plan.
Limitations in the availability of specialized resuscitation or laboratory support at that time.

The birth plan may change as events unfold, and the team will discuss possible options with you in advance. If you have any questions, talk through your expectations and concerns with the maternity team.

Who decides on the mode of delivery

The choice of mode of delivery is a joint process between you and the medical team, taking into account your preferences and the clinical situation. The patient states her expectations, and the team assesses the pregnancy, test results, and the condition of the fetus. If HELLP syndrome or other complications are suspected, decisions are based on current data and the team's readiness for rapid action. The plan is agreed in advance but may change for medical reasons during labor.

The patient's preferences and questions about partner presence or pain relief methods.
Assessment of the mother's condition: examination, tests, and dynamic monitoring.
Fetal assessment: monitoring, ultrasound, and response to the labor process.
The obstetrician and midwife form the clinical picture and propose options.
The anesthesiologist discusses available analgesia methods and possible limitations.
The neonatologist becomes involved if there is a risk of prematurity or a threat to the baby.
The presence of indications for urgent operative delivery that would alter the management plan.

The final decision is made jointly with priority given to the safety of the mother and baby. Discuss your preferences and questions in advance so the team can take them into account when planning.

What to discuss with your doctor in advance

Before the consultation, it’s helpful to prepare questions so you have time to discuss the birth plan and possible variations. Plan to talk about your expectations, current test results, and how the team will respond to changes. With HELLP syndrome it’s especially important to discuss monitoring, restrictions, and possible courses of action.

Can we discuss the format of childbirth I prefer and whether it is appropriate?
Is partner presence allowed, under what conditions, and what restrictions apply?
What pain relief options are available and how suitable are they for my situation?
Will my previous birth experience, cesarean section, or complications be taken into account?
Are there chronic conditions that could affect the birth plan?
Which ultrasound and test results need to be considered when making decisions?
What is the plan of action in case of sudden deterioration in the mother’s or fetus’s condition?
What should I pack for the maternity hospital and which documents should I prepare?
When should I go to the clinic once labor starts or if worrying symptoms occur?
What are the postpartum stay conditions and visiting rules for relatives?

Write down the answers and bring your test results and documents to the appointment. If anything remains unclear, ask follow-up questions during the consultation.

How preparation for this type of delivery is carried out

Preparation for childbirth when complications are present is a step-by-step, transparent process aimed at reducing risks and coordinating the team's actions. It includes review of current tests and examinations, discussion of possible delivery scenarios, and ensuring the maternity ward's organizational readiness. With HELLP syndrome, preparation focuses especially on laboratory monitoring and readiness to make rapid decisions.

Consultation with an obstetrician-gynecologist to assess the condition and choose possible delivery options.
Review of the maternity record and current laboratory results to inform decision-making.
Performing scheduled pregnancy-term examinations and fetal assessment.
Consultation with an anesthesiologist to discuss pain relief and possible limitations.
Coordinating the monitoring plan for the mother and fetus during and after delivery.
Preparing the partner: rules for presence and their role in the birth process.
Assembling documents and a basic list of items for the hospital stay.
Arranging access to relevant specialists and resuscitation/intensive-care support if necessary.

Preparation helps make the plan clear and practical to implement, but it does not guarantee that the scenario will remain unchanged. During labor, the team prioritizes the safety of the mother and baby and will adjust the plan as needed.

How labor usually proceeds in this situation

The labor process when HELLP syndrome is suspected or confirmed is organized to obtain information quickly and make decisions as needed. The scenario is similar to routine labor but with intensified monitoring and frequent laboratory checks. The team agrees on a plan in advance, which can be changed for the safety of the mother and baby.

Admission to the hospital: registration, brief interview, and admission to the labor ward.
Initial examination and measurement of the mother's vital signs.
Rapid assessment of blood tests and coagulation profile if necessary.
Connection to fetal monitoring to assess fetal heart activity.
Monitoring of contractions and the progress of cervical dilation.
Regular repeat tests and assessment of liver function and platelet levels.
Discussion and administration of appropriate analgesia/anesthesia with the anesthesiologist, as indicated.
Management of the second (pushing) stage under the supervision of the obstetrician and midwife, with team support as needed.
Delivery of the baby and initial assessment by a neonatologist if required.
The first hours after delivery: observation of the mother and newborn, with adjustments to the plan as necessary.

The team follows a prearranged plan but remains able to make changes as events unfold. If you have any wishes or concerns, discuss them with your doctor before hospitalization.

Analgesia during labor with HELLP syndrome

Discussion of pain relief begins in advance and continues on admission to the maternity unit. The choice of method depends on current test results, the condition of the mother and fetus, and the anesthesiologist’s capabilities. The plan is discussed by the physician and obstetrician with input from the anesthesiologist, and it may be adjusted during labor for safety.

Preliminary consultation with an anesthesiologist to assess possible methods and limitations.
Review of blood tests, especially platelet count, before considering regional anesthesia.
Regional techniques (epidural or spinal) are considered if there are no contraindications.
Systemic pharmacologic analgesia may be an option when regional anesthesia is limited or contraindicated.
Non‑pharmacologic methods and positional support as adjuncts to analgesia.
The decision is made by the anesthesiologist together with the obstetric team and the patient.
The method of analgesia can be adjusted during labor depending on the situation.

Discuss your preferences and possible limitations in advance with the maternity team. Remember that complete elimination of pain is not always possible; the priority is the safety of the mother and baby.

How safety and monitoring are ensured in this childbirth format

In this format the team's main task is to detect changes in a timely manner and respond promptly. Monitoring is carried out systematically: the mother's condition is assessed, the fetus is observed, and the progress of labor is monitored so that tactics can be adjusted if necessary.

This is a normal part of labor management, not a sign of an inevitable problem.

Observation by the physician and midwife of blood pressure, overall condition, and symptoms.
Assessment of the fetal heart rate and connection of cardiotocography (CTG) when indicated.
Monitoring the dynamics of labor activity and cervical dilation.
Reassessment of tests and laboratory monitoring as needed.
Availability of an anesthesiologist on standby and the ability to quickly change the method of analgesia/anesthesia.
The team's readiness to proceed to operative delivery if the condition worsens.
Involvement of a neonatologist to assess and support the newborn immediately after birth.

Monitoring helps the team make timely decisions in the interests of the mother and baby. If anything causes concern, the team will explain the reasons and propose possible courses of action.

What happens if labour doesn't go according to plan

Even a birth plan agreed in advance remains flexible and may change in response to new information. If circumstances change, the team will explain the reasons and propose a safe alternative approach. In case of complications, including HELLP syndrome, the priority remains the safety of the mother and the baby.

Reviewing the plan with an explanation of the current indications and possible courses of action.
Suspending partner-supported labour and asking the partner to temporarily leave the delivery room if necessary.
Moving from spontaneous labour to induction/augmentation or to cesarean section when clinically indicated.
Abandoning an upright position and transferring to a more controlled position when indicated.
Limiting or withholding epidural anesthesia if there are contraindications.
Increased monitoring of mother and fetus with readiness for surgical intervention.
Revising a plan that favours minimal intervention if it puts the baby or mother at risk.

Changing tactics is a normal part of safe labour management, not a sign of failure. The team will discuss with you in advance the reasons for changes and the next steps.

Possible risks and limitations

Any mode of delivery has medical limitations; this is a normal part of planning a safe birth. In complicated conditions, including HELLP syndrome, decisions are based on current data and the ability to perform surgical intervention. Discuss in advance with the team which changes to the plan might be needed.

Any chosen mode of delivery has medical limitations and indications.
Risks depend on the condition of the mother, the fetus, and the course of the pregnancy.
Additional interventions or expedited delivery may be required during labour.
A low platelet count or other abnormalities may limit the use of regional anesthesia.
Infection or organizational reasons may temporarily restrict the presence of a partner.
The plan may be changed by the obstetrician and midwife based on test results, monitoring, and the clinical picture.
Do not rely solely on someone else’s experience; safety decisions are made individually.

Discuss these issues in advance with the maternity team so you understand possible scenarios. In any case, the priority is the safety of the mother and baby, and the plan may change during labour.

The first minutes and hours after birth

Immediately after birth the team performs an initial assessment of the mother and baby and arranges monitoring for the next few hours. CTG (cardiotocography) and a neonatal examination by a neonatologist are always performed in the clinic. With HELLP syndrome, laboratory monitoring and attention to the mother's condition may be intensified, and the sequence of actions adjusted to the situation.

Initial skin‑to‑skin contact and assistance with the first latch.
CTG and a neonatal examination by a neonatologist are mandatory.
Assessment of the mother's condition by the physician and obstetrician: blood pressure, bleeding, and general well‑being.
The neonatologist is ready to provide additional care to the newborn if needed.
Additional tests and laboratory monitoring are performed as necessary.
Breastfeeding counseling and basic care assistance.
Transfer to the postpartum ward after stabilization of mother and baby.
Monitoring during the first hours: regular checks and observation of both.

The sequence may vary depending on the clinical situation, and the team will explain each step. If you have questions or preferences about care immediately after birth, discuss them with your physician in advance.

Role of the physician and the team

Management of childbirth is a team effort in which the physician not only delivers the baby but also continuously assesses the condition of the mother and the fetus. Decisions are made based on the clinical picture, test results, and monitoring, and specialists are involved when necessary. The team coordinates its actions, explains what is happening to the patient, and acts with safety as the priority.

Obstetrician-gynecologist — risk assessment, clinical decision-making, and leadership of the labor process.
Physician and midwife — regular examinations, support during labor, and monitoring the progress of cervical dilation.
Anesthesiologist — consultation about pain relief and management of its administration when indicated.
Neonatologist — examination and care of the newborn immediately after birth.
Operating room team — readiness for operative delivery if required.
Laboratory and resuscitation team — rapid support if test results or the patient's condition change.
Communication with the patient — explaining the situation and discussing options in an understandable way.
Coordination of actions — joint decision-making and quick response to changes.

The team works to ensure you understand the steps and the reasons for decisions at all times. Do not hesitate to ask questions and express your preferences — they will be considered in planning.

How this format of labor is convenient for the patient

The format of labor with enhanced monitoring gives a clearer idea of how the team and you will act in different situations.

This is especially important when HELLP syndrome is suspected or confirmed, as a pre-agreed plan reduces uncertainty.

This approach allows you to discuss expectations, pain relief, and organizational matters before admission.

A clear plan for labor management with agreed stages and contingency options.
The opportunity to discuss personal wishes and limitations in advance.
Less uncertainty due to regular communication with the team.
The ability to choose and arrange for the presence of a specific physician.
Access to pain-management consultation involving an anesthesiologist.
Systematic monitoring of mother and fetus in the delivery room, including cardiotocography (CTG).
A team prepared to change tactics quickly if necessary.
Support for the partner and organizational arrangements by agreement.

Discuss with the team which of these points are a priority for you.

Remember that the plan remains flexible and will be adjusted according to medical indications.

How a pre-delivery consultation is conducted

A pre-delivery consultation is a discussion during which the team gathers information and agrees on a safe plan of action. If HELLP syndrome or other complications are suspected, the discussion focuses on current test results and possible delivery scenarios. At the appointment you state your expectations, show your maternity record (exchange card), and review test results with the team. Sometimes additional tests or a consultation with an anesthesiologist and a neonatologist are required.

Medical history: illnesses, previous births, and current symptoms.
Review of the maternity record (exchange card) and all available test results.
Assessment of tests and discussion of which additional tests may be needed.
Discussion of your preferences regarding the type of delivery and partner presence.
Explanation of possible limitations and situations when the plan may change.
Joint selection of a safe mode of delivery, taking risks into account.
Discussion of warning signs that should prompt immediate travel to the clinic.
Answers to questions and, if needed, scheduling of follow-up consultations.

Bring your maternity record (exchange card), test results, and a list of questions to the appointment. If doubts remain after the consultation, schedule an additional meeting or a phone consultation.

Please note that online consultations are available for patients from other cities. We often receive requests from Zaporizhzhia, Pavlohrad, Kamenskoye (Dniprodzerzhinsk), Novomoskovsk (Samar), Kryvyi Rih, Nikopol, Marganets, Sinelnikovo, Pokrov, Zhovti Vody, and other cities.

Preparation for admission to the maternity ward for childbirth

Brief practical preparation helps reduce anxiety and speed up admission to the maternity ward. With complications, including HELLP syndrome, it is especially important to have all documents and up-to-date test results on hand. Before you travel, discuss with your doctor which tests are needed and which medications to continue.

Documents: passport, health insurance, and emergency contact details.
Antenatal record (exchange card) with notes on pregnancy care and referrals.
Current blood test results, coagulation panel, and baseline ultrasounds.
Any regularly taken medications — be sure to confirm these with your doctor in advance.
A basic set of essentials for the mother for the hospital stay.
Basic items for the newborn, packed without unnecessary extras.
Partner’s items and written consent for their presence if you plan a partner-supported birth.
Doctor’s contact information and an action plan: which symptoms should prompt a trip to the clinic.

Take everything to your consultation and check with the maternity team for any additions. If you have questions about documents or medications, discuss them with your doctor in advance.

Conditions of the Genesis Dnepr Maternity Ward

The maternity ward is organized to provide medical supervision and support at all stages of childbirth. Obstetric, anesthesiology, and neonatology services operate here, ready for both planned and emergency situations. In case of suspected or confirmed HELLP syndrome, intensified monitoring and laboratory control are available.

Delivery rooms equipped for safe labor management and monitoring.
Recovery rooms allowing rooming-in for mother and baby.
A neonatologist available 24/7 for initial examination and newborn support.
Anesthesiology service for consultations and administration of pain relief/anesthesia when indicated.
A surgical team and access to operative delivery if necessary.
Partner-supported births possible by prior arrangement and subject to organizational conditions.
Individual support by the team: the doctor and midwife explain the course and available options.
Laboratory and resuscitation support for prompt clinical decision-making.

If you have questions about the conditions or specifics of your stay, discuss them in advance with the maternity team. This will help create a clear plan and accommodate your preferences.

When to seek urgent medical attention

If you notice worrying symptoms, do not delay seeking care or wait for a scheduled appointment. If HELLP syndrome is suspected, some signs require immediate evaluation by healthcare professionals. Below are symptoms that, if they occur, mean you should urgently go to the maternity ward or call emergency services.

Any bleeding, including bloody discharge or heavy bleeding, at any stage of pregnancy.
Your water breaks or you notice any leaking of amniotic fluid, even a small amount.
Regular, strong contractions that do not stop and occur frequently.
Decreased or absent fetal movements compared with your usual pattern.
A sudden rise in blood pressure or persistently high blood pressure higher than usual.
Severe headache that does not go away after rest and interferes with your normal functioning.
Changes in vision: flashing spots or lights, blurriness, or sudden double vision.
Marked weakness, severe shortness of breath, or problems with speech and coordination.
Fever, chills, or other signs of infection accompanied by feeling unwell.
Any sudden change in how you feel that seriously concerns you.

If you experience one or more of these signs, go to the maternity ward or labor and delivery unit immediately or call emergency medical services.

Frequently Asked Questions

Question: Can this type of delivery be chosen in advance?
Answer: You can discuss and preliminarily agree on the delivery format, but the final decision depends on the clinical situation and test results.
Question: Is this type of delivery suitable for everyone?
Answer: Not for everyone — the appropriateness is assessed based on the condition of the mother, the fetus, and test results; it is decided individually.
Question: Can the birth plan be changed during labor?
Answer: Yes, the plan can be changed for medical reasons if necessary for the safety of the mother or the baby.
Question: Can the format be discussed before labor starts?
Answer: Yes, it is recommended to do so at a consultation, where the maternity record and tests are reviewed and options are discussed.
Question: Can I give birth with my partner present?
Answer: In most cases, yes. Partner presence is agreed in advance, but in certain circumstances they may be asked to temporarily leave the delivery room.
Question: How can I prepare my partner for the birth?
Answer: Discuss their role in the delivery, visiting rules, and possible restrictions; it is useful to attend a joint consultation and receive brief instruction from the team.
Question: Is epidural anesthesia available?
Answer: The possibility of epidural or spinal anesthesia is assessed by the anesthesiologist based on tests (especially platelet count) and the current condition; the decision is made individually.
Question: Who decides on pain relief?
Answer: The decision is made jointly by the patient, the anesthesiologist, and the obstetric team, taking into account test results and the clinical situation.
Question: What happens if the chosen pain relief method is not suitable?
Answer: Alternative methods or tactics will be considered, and the pain-relief plan can be adjusted during labor if necessary.
Question: When should I go to the clinic?
Answer: Go when you have regular strong contractions, your waters break, you have heavy bleeding, decreased fetal movements, or a sudden worsening of your condition.
Question: What should I take to the maternity hospital?
Answer: Bring your documents, maternity record, up-to-date test results, and basic items for your stay; ask at the consultation for the exact list.
Question: Is the maternity record and test results necessary?
Answer: Yes, the maternity record and recent tests help quickly assess the situation and make decisions upon admission.
Question: Can I come with already completed tests?
Answer: Yes, bring all existing results — this will speed up assessment and birth planning.
Question: What happens if a cesarean section is needed?
Answer: The team will explain the indications and prepare you for operative delivery; the decision is made on medical grounds in the interest of the mother and baby.
Question: How long is the usual hospital stay after delivery?
Answer: The duration depends on the type of delivery and the condition of the mother and baby; the team will explain the exact timing after delivery.
Question: What happens immediately after the baby is born?
Answer: Typically — initial contact and help with latching, a mandatory neonatal examination by a neonatologist, and monitoring of the mother; the team will explain the sequence of steps.
Question: Can I get a second opinion if a management plan was already proposed earlier?
Answer: Yes, you can discuss a second opinion with another medical team or request an additional consultation at the clinic.
Question: What is discussed at the pre-labor consultation?
Answer: The consultation includes taking the medical history, reviewing the maternity record and tests, discussing your wishes, possible limitations, and the plan of action for different scenarios.