A clinical review of HELLP syndrome

Abstract

Objective : To obtain clinical data for the antenatal care, prevention, and treatment of HELLP syndrome.

Methods : Twelve patients were retrospectively analyzed out of the 10,502 pregnant women de￢livered beyond 20 weeks of gestation from June 1994 through December 1999 at Ajou University hospital, department of Obstetrics and Gynecology. We analyzed the demographic and obstetrical factors that influenced this disorder and the complications that occurred in mothers, fetuses and neonates.

Results : The incidence of HELLP syndrome was 0.11 % (12/10,502) , and was 2.9% in pregnant women with severe preeclampsia-eclampsia. The mean value of maternal age, gestational age and neonatal birth weight was 30.7 ± 4.7 years old, 32.2 ± 4.4 gestational weeks and 1,318 ± 514gm, respectively. According to the classification of platelet count, class I was 67% and class II was 25%. In the hematologic findings, the mean value of the nadir of hemoglobin, hematocrit and platelet count was 11.2±2.4gm/dl, 30.7 ± 5.4% and 58,000±55,660/mm3, respectively. The mean level of the maximum of SGOT and SGPT was 431 ± 5421U/L, 301 ± 351IU/L, and that of LDH was 771.5 ±483.6IU/L. Ten cases were delivered by cesarean section. Maternal complications occurred in 6 cases (50%) and included acute renal failure (2 cases), pulmonary failure (2 cases), postpartum bleeding (1 case), abruptio placentae (1 case) and DIC (1 case). Perinatal complications included IUGR infants (11 cases), HAM (2 cases) and sepsis (1 case). The pathologic findings of the placenta showed signs of infarction in most cases (78%), in addition to acute chorioamnionitis (56%), acute atherosis (23%) and intervillous fibrin deposit (23%). Conclusion : HELLP syndrome represents very poor maternal, perinatal outcomes. More studies are needed to be performed in the pathogenesis, early diagnosis, and proper management of the disorder to improve the maternal, perinatal outcomes.