Partial HELLP syndrome: Maternal, perinatal, subsequent pregnancy and long-term maternal outcomes (original) (raw)
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Pregnancy complicated by pre-eclampsia–eclampsia with HELLP syndrome
International Journal of Gynecology & Obstetrics, 2001
Objecti¨e: To determine the incidence of, and assess the relationship between liver enzymes and platelet counts Ž. with the severity of HELLP hemolysis elevated liver enzymes and low platelet count syndrome, and describe incidences of serious maternal complications. Materials and methods: Retrospective descriptive study of patients with pre-eclampsia᎐eclampsia complicated by HELLP syndrome that occurred over a 3-year period in Panama. The primary outcome included: platelet count; serum aspartate aminotransferase; serum alanine aminotransferase; symptoms and complications among class 1, 2, and 3 HELLP. Results: There were 558 pregnancies complicated by severe pre-eclampsia and 26 by eclampsia. The incidence of HELLP syndrome among women with severe Ž. pre-eclampsia in our population was 12% and among women with eclampsia was 34.6%, P-0.0008 ; with a total incidence of 16%. Epigastric pain, visual symptoms and hematuria increased with the severity of HELLP syndrome. Ž. Hematuria was the fourth symptom, but was significantly Ps 0.002 associated with class 1 HELLP. There were significant differences in the platelet count, and liver enzymes among the classes of HELLP syndrome. Abruptio placentae, acute renal failure and disseminated intravascular coagulation were the most frequent maternal complications. There were two maternal deaths. Conclusions: This study supports the theory that HELLP syndrome is associated with increased maternal morbidity and mortality. Our data suggest that certain subgroups of patients with Ž. class 1 HELLP syndrome 'classic or true HELLP' are at increased risk for serious maternal complications, including those with: platelet counts below 50 000rl; lactic dehydrogenase G 2000 IUrl; aspartate aminotranferase G 500 IUrl; alanine aminotransferase G 300 IUrl; and hematuria.
Subsequent pregnancy outcome in women with a history of HELLP syndrome at ≤ 28 weeks of gestation
American Journal of Obstetrics and Gynecology, 2003
Objective: The purpose of this study was to describe subsequent pregnancy outcome in women with a history of hemolysis, elevated liver enzymes, and low platelet count syndrome for which delivery occurred at ≤ 28 weeks of gestation during the index pregnancy. Study Design: A descriptive report of women with previous hemolysis, elevated liver enzymes, and low platelet count syndrome who were delivered between August 1984 and July 1998 at the E.H. Crump Women's Hospital (Memphis, Tenn) and between March 1994 and July 1998 at the Central Baptist Hospital (Lexington, Ky). To have adequate time to study subsequent pregnancy outcome, only patients who were delivered >2 years before the analysis were included. Medical records of the index pregnancy and subsequent outcomes were available for review. Results: Adequate follow-up data were available in 69 patients; the median duration of follow-up was 5 years (range: 2-14 years). There were 76 subsequent pregnancies among 48 women, of which 62 pregnancies (82%) progressed beyond 20 weeks of gestation. Preeclampsia developed in 34 of 62 subsequent pregnancies (55%). Recurrent hemolysis, elevated liver enzymes, and low platelet count syndrome developed in 4 of these pregnancies (6%), and abruptio placentae developed in 3 of these pregnancies (5%). There were no cases of eclampsia in our population. Delivery before 37 weeks of gestation occurred in 33 of the cases (53%), and 17 of the newborn infants (27%) were small for gestational age (<10th percentile). The perinatal mortality rate was 11%. Conclusion: Patients with a history of hemolysis, elevated liver enzymes, and low platelet count syndrome at ≤ 28 weeks of gestation during the index pregnancy are at increased risk for obstetric complications in subsequent pregnancies. Overall, however, the rate of recurrent hemolysis, elevated liver enzymes, and low platelet count syndrome is only 6%. (Am J Obstet Gynecol 2003;188:1504-8.)
American Journal of Obstetrics and Gynecology, 2000
OBJECTIVE: This study was undertake to determine risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. STUDY DESIGN: Maternal medical records of pregnancies complicated by HELLP syndrome managed between July 1, 1992, and April 30, 1999, were reviewed. Risk factors evaluated included maternal age, parity, race, previous preeclampsia, chronic hypertension, gestational age at diagnosis, mean arterial blood pressure, nadir blood platelet count (<50,000 cells/µL vs ≥50,000 cells/µL), and peak serum levels of aspartate aminotransferase and lactate dehydrogenase. Maternal outcome variables analyzed included eclampsia, abruptio placentae, disseminated intravascular coagulopathy, pulmonary edema, pleural effusion, ascites, acute renal failure, liver hematoma, need for transfusion of blood products, cesarean delivery, and death. Statistical analysis was performed with the Student t test, the χ 2 test, and logistic regression analysis. RESULTS: A total of 183 women with HELLP syndrome were studied. Eclampsia was present in 6%, abruptio placentae was present in 10%, and disseminated intravascular coagulopathy was present in 8%. Fortyone women (22%) required transfusion of blood products. Incidence of eclampsia significantly decreased with increasing gestational age, from 16% at ≤28 weeks' gestation to 3% at >32 weeks' gestation (P < .05) and was higher among African American patients than among white patients (12% vs 3%; P < .05). Logistic regression analysis showed an independent relationship between eclampsia and race (P < .05). Incidence of abruptio placentae was higher among women with previous preeclampsia than among women without this clinical history (26% vs 5%; P < .05). Disseminated intravascular coagulopathy was significantly associated with abruptio placentae (P < .0001) and acute renal failure (P < .0001). A nadir platelet count of <50,000/µL, a peak serum aspartate aminotransferase level of >150 U/L, and a peak serum lactate dehydrogenase level of >1400 U/L were not independent risk factors for adverse outcome. CONCLUSIONS: Among women with HELLP syndrome, African American race is a risk factor for eclampsia. Both acute renal failure and abruptio placentae are associated with disseminated intravascular coagulopathy. Laboratory parameters of HELLP syndrome are not independent risk factors for adverse maternal outcome. (Am J Obstet Gynecol 2000;183:444-8.)
HELLP syndrome--a pregnancy disorder with poor prognosis
Nepal Medical College journal : NMCJ, 2008
HELLP syndrome is a pregnancy-specific disorder defined by hemolysis, elevated liver enzymes and low platelet count that is found in parturients, more frequent in older multiparas. It is frequently associated with severe preeclampsia or eclampsia, but can also be diagnosed in the absence of these disorders. The etiology of HELLP syndrome is unknown, and the pathogenesis of this disorder (including the hepatological manifestations) is not fully understood. The most widely accepted hypotheses are: a change in the immune feto-maternal balance, platelet aggregation, endothelial dysfunction, arterial hypertension and an inborn error of the fatty acid oxidative metabolism. Hepatic involvement occurs by intravascular fibrin deposition and hypovolemia. Serum LDH and platelet count are the two most important clinical tools for disease assessment. LDH reflects both the extent of hemolysis and hepatic dysfunction. Maternofetal complications cause a 7.0-70.0% perinatal mortality rate and a 1.0-...
American Journal of Obstetrics and Gynecology, 2000
Our purpose was to determine whether the onset of the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome in women at ≤28.0 weeks' gestation is associated with an increased risk of adverse maternal and perinatal outcomes in comparison with the risk for women with severe preeclampsia but without the HELLP syndrome at a similar gestational age. STUDY DESIGN: Sixty-four patients with either the HELLP syndrome (n = 32) or severe preeclampsia but absent HELLP syndrome laboratory test results (n = 32), admitted at ≤28.0 weeks' gestation between July 1, 1992, and April 30, 1999, were studied. Maternal and perinatal outcomes were compared between the 2 groups. Statistical analysis was performed by the Student t test and the Fisher exact test. RESULTS: There were no significant differences between the 2 groups regarding African-American race (59% vs 75%), nulliparity (50% vs 56%), or the use of corticosteroids (59% vs 78%). There were no maternal deaths. One woman with the HELLP syndrome had a liver hematoma. The rate at which transfusion of blood products was required was significantly greater in women with the HELLP syndrome than in those with severe preeclampsia only (25% vs 3%; P < .05). There were no significant differences between the 2 groups with respect to eclampsia (16% vs 13%), abruptio placentae (6% vs 9%), disseminated intravascular coagulopathy (13% vs 0%), pulmonary edema (13% vs 6%), acute renal failure (3% vs 0%), pleural effusion (3% vs 3%), or ascites (6% vs 16%). No significant differences were found between the 2 groups with respect to neonatal death (11% vs 17%), respiratory distress syndrome (78% vs 86%), or composite neonatal morbidity. CONCLUSIONS: Except for the need for transfusion of blood products in women with the HELLP syndrome, onset at ≤28.0 weeks' gestation is not associated with an increased risk of adverse maternal or neonatal outcomes in comparison with the risk for women with severe preeclampsia but without the HELLP syndrome at a similar gestational age. (Am J Obstet Gynecol 2000;183:1475-9.)
2013
Objective: This study aimed to determine the maternal and neonatal outcomes in hemolysis, elevatedliver enzymes and low platelets syndrome (HELLP), partial HELLP syndrome (PHS) and severe pre-eclampsia:an eleven years experience of an obstetric center in the North of Iran. Methods: This retrospective observationalstudy was done on pregnant women admitted in the Yahyanejad Hospital in the Babol University ofMedical Science during 1998-2009. A total of 327 pregnant women were categorized into three groups: severepre-eclampsia, PHS and HELLP syndrome. Data were analyzed by appropriate tests for continuous orcategorical outcomes with differences considered significant if P < 0.05. Findings: Our finding demonstratedthat the rate of caesarean section, blood transfusion, acute renal failure, admitting in Intensive Care Unitand liver hematoma were significantly greater in the pregnancy with HELLP syndrome versus severepre-eclampsia.(p<0.05).Conclusion: Maternal and neonatal morbidities increased among that HELLP syndrome.So, immediate diagnosis and proper management could be attempted to improve maternal and prenataloutcomes.
A study of maternal and perinatal outcome in cases of HELLP and partial HELLP syndrome
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2017
Background: The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10-20% of cases with severe preeclampsia. The objective of the present prospective study is to study on incidence, diagnosis, and variable presentations of HELLP syndrome in preeclampsia to analyse the severity and complications, as it is associated with maternal, perinatal morbidity and mortality. HELLP syndrome is difficult to diagnose when it presents with atypical clinical features.Methods: In the prospective study of 300 admitted cases with more than 20 weeks of gestation, were having preeclampsia. The selected cases were analyzed clinically with relevant history, clinical data and detailed laboratory investigations made for better analyses of complications and outcome in HELLP syndrome.Results: Under further clinical diagnosis of 300 cases of preeclampsia, 34 cases (11.33%) were of HE...
Comparison of perinatal and maternal outcomes of severe preeclampsia, eclampsia, and HELLP syndrome
Journal of the Turkish German Gynecological Association, 2011
To compare maternal and perinatal outcomes in pregnancies complicated by severe preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzyme levels, and low platelets) syndrome. Maternal and neonatal charts of 1,222 consecutive pregnancies complicated by severe preeclampsia, eclampsia, or HELLP syndrome at our maternal-perinatal unit were reviewed. Patients were divided into three groups: 903 (73.9%) with severe preeclampsia, 123 (10.1%) with eclampsia, and 196 (16.0%) with HELLP syndrome. The overall incidence of adverse maternal outcome was 5.9%. The rates of adverse maternal outcomes for women with HELLP syndrome and eclampsia were higher than for severe preeclampsia (13.8% vs. 11.4% vs. 3.4%, respectively) (p=0.000). Birth weight was lower in patients with HELLP syndrome than in patients with eclampsia and severe preeclampsia (p=0.005). No significant difference in neonatal morbidity was found among the three groups. Perinatal mortality tended to be higher in the severe ...
Maternal and fetal outcome in HELLP syndrome
International Journal of Clinical Obstetrics and Gynaecology, 2019
Background: HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome is a severe complication of pregnancy with high risk for both mother and fetus and it complicated 0.2-0.6 % of all pregnancies. This present study was designed to understand maternal and fetal outcome in HELLP syndrome complicating pregnancy. Methods: Study was conducted over a period of 24 months. Antenatal women above 20 weeks gestation, who fulfilled the criteria for HELLP syndrome, were included in the study. Detailed histories, clinical examination, blood pressure measurement, obstetric examination, blood investigation were done. Maternal and fetal complications were noted and subjected to statistical analysis. Results (n=40): Incidence of HELLP syndrome was 0.7% of all deliveries and 22.4% of preeclampsia & eclampsia cases. Mean gestational age was 32.5 weeks. Common maternal complication was acute renal damage seen in 30% cases. Perinatal mortality was 42.5%. Conclusion: HELLP Syndrome is a life threatening complication, associated with maternal and fetal risk. It requires multidisciplinary approach and tertiary hospital care.