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Human Circadian Phenotyping and Diurnal Performance Testing in the Real World

Published on: April 7, 2020

Is there a diurnal pattern in the clinical symptoms of HELLP syndrome?

Steven V Koenen1, Anjoke J M Huisjes, Jules Dings

  • 1Department of Perinatology and Gynaecology, University Medical Centre Utrecht, The Netherlands. svk4@yahoo.com

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
|April 4, 2006
PubMed

Insights

HELLP syndrome, characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets, shows a diurnal pattern with symptom exacerbation at night and recovery during the day. Diagnosis is often delayed due to initial lab criteria not being met.

Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Critical Care Medicine

Background:

  • HELLP syndrome is a severe obstetric complication.
  • Understanding temporal patterns in HELLP syndrome is crucial for timely management.
  • Previous research has not extensively explored diurnal variations in HELLP symptoms.

Purpose of the Study:

  • To investigate the presence and characteristics of a diurnal pattern in the clinical presentation and progression of HELLP syndrome.
  • To analyze the timing of symptom onset, diagnosis, and recovery in relation to the time of day.
  • To assess the delay between symptom onset and fulfillment of diagnostic criteria.

Main Methods:

  • Retrospective study of 134 pregnancies with HELLP syndrome.
  • Categorization of symptom onset, medical consultation, blood sampling, diagnosis, and symptom decrease into day, evening, and night periods.
  • Analysis of biochemical parameters at presentation and within 24 hours.

Main Results:

  • Significant increase in symptom onset and doctor consultation during evening and night (p < 0.001).
  • Significant increase in diagnosis and symptom decrease during the day (p < 0.001).
  • Diagnostic laboratory criteria, particularly platelet counts, were met at presentation in only 49.3% of cases, with platelet decrease occurring hours later.

Conclusions:

  • A distinct diurnal pattern exists in HELLP syndrome, with symptom exacerbation at night and improvement during the day.
  • There is a significant delay between the initial onset of HELLP symptoms and the fulfillment of diagnostic laboratory criteria.
  • This diurnal pattern and diagnostic delay highlight the need for vigilant monitoring and prompt intervention in HELLP syndrome.
Abstract

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