Pregnancy complicated by pre-eclampsia-eclampsia with HELLP syndrome

To determine the incidence of, and assess the relationship between liver enzymes and platelet counts with the severity of HELLP (hemolysis elevated liver enzymes and low platelet count) syndrome, and describe incidences of serious maternal complications.

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.

There were 558 pregnancies complicated by severe pre-eclampsia and 26 by eclampsia. The incidence of HELLP syndrome among women with severe 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. Hematuria was the fourth symptom, but was significantly (P=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.

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 class 1 HELLP syndrome ('classic or true HELLP') are at increased risk for serious maternal complications, including those with: platelet counts below 50000/microl; lactic dehydrogenase> or = 2000 IU/l; aspartate aminotranferase> or = 500 IU/l; alanine aminotransferase> or = 300 IU/l; and hematuria.