About 2 percent of moms die from HELLP syndrome, the society says, while between 7 percent and 15 percent of the babies don't survive. Fully one-fourth of women suffer serious complications including kidney failure and liver rupture or fluid in the lungs. It's unclear how often the syndrome occurs in subsequent pregnancies, with estimates ranging from 5 percent to 27 percent. All the studies find that the HELLP mothers have increased risk for obstetric complications in general with subsequent pregnancies and those with pre-term severe preeclampsia and HELLP have an elevated long-term risk for cardiovascular disease.

Although early delivery is risky for a baby, the baby does "as well or better" than it would inside the womb at that point, Varner says. And mom is always better off.

Time factors help. Preeclampsia is more likely to develop the closer a woman gets to her due date. And late onset of a complication obviously helps baby's chance of thriving. "Where it is most dangerous is when it's in women remote from their due dates," Varner says. Delivering a baby "real early is a bad thing no matter how you look at it, and we have to make some pretty unpleasant choices."

HELLP syndrome babies typically do very well if they weigh more than two pounds at birth, according to the society, their outcomes similar to those of non-HELLP babies of comparable size. For those who are smaller, outcomes vary greatly. Many deaths are the result of the placenta prematurely separating because of the syndrome or intrauterine asphyxia, where the baby dies from lack of oxygen. And extreme prematurity also kills simply because the baby isn't developed enough to survive.

Those anxious to increase recognition of HELLP say they battle misconceptions. Pilkington was told, for instance, that she couldn't have HELLP or preeclampsia in a second pregnancy; it's the provenance of a first-timer. That's wrong, although preeclampsia is more common in a first pregnancy. HELLP doesn't seem to care how many pregnancies a woman has had.

Varner says women with any new onset of symptoms during pregnancy, including abdominal pain, shortness of breath, headaches or visual symptoms should see their care provider, although it could be something else.

Anderson says HELLP is clearly a response of the mother's body to the pregnancy, but why it reacts as it does is unclear. Whether it's due to excessive hormones or something else is simply a mystery. Infants developing in the womb are "basically parasites," he says, who do what they need to increase circulation and survive. They are known to produce substances that raise mom's blood pressure in order to increase the circulation that sustains them. Is that part of it? It's unknown.

When the baby is delivered, Anderson says, the mom's recovery is usually "almost miraculous."

More information about HELLP syndrome is available online at www.hellpsyndrome.org.

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E-mail: lois@desnews.com