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Factors affecting maternal and perinatal outcomes in HELLP syndrome: evaluation of 126 cases
M Erdemoğlu1, U Kuyumcuoğlu, A Kale
1Department of Obstetrics and Gynecology, Dicle University Medical School, Diyarbakir, Turkey.
Insights
HELLP syndrome presents significant maternal and perinatal risks, with laboratory markers aiding in assessing maternal complications but not predicting perinatal outcomes. Early diagnosis and specialized care are crucial for improving outcomes in this condition.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Critical Care Medicine
Background:
- HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome is a severe obstetric complication.
- It is associated with significant maternal and fetal morbidity and mortality.
Purpose of the Study:
- To characterize HELLP syndrome, including its clinical features and maternal-fetal outcomes.
- To evaluate the utility of laboratory parameters in predicting outcomes.
Main Methods:
- A retrospective cross-sectional study of 126 HELLP syndrome cases.
- Data were collected from January 2004 to December 2008 at a tertiary referral center.
- Descriptive statistical analysis was employed.
Main Results:
- HELLP syndrome complicated 0.9% of deliveries.
- Commonly associated with preeclampsia (62.6%) and eclampsia (22.2%).
- High rates of complications including intra-abdominal bleeding (9.5%), maternal mortality (7.93%), and perinatal mortality (11.9%) were observed.
Conclusions:
- HELLP syndrome is linked to substantial maternal and perinatal complications.
- Laboratory parameters are more effective in evaluating maternal risks than predicting perinatal results.
- Standardized antenatal follow-up and prompt transfer to expert centers are vital for early diagnosis and improved management.
Objectives:
To ascertain the characteristics, clinical features, and maternal fetal outcome in HELLP (hemolysis elevated liver enzymes, low platelets) syndrome at a tertiary referral center.
Material And Methods:
This was a cross-sectional study carried out at Dicle University between January 2004 and December 2008 in which the charts of 126 cases were retrieved retrospectively and data analyzed descriptively.
Results:
Of all deliveries 0.9% were complicated by HELLP syndrome. Of the cases with HELLP syndrome 79 (62.6%) had preeclampsia, 28 (22.2%) had eclampsia and 19 (15.2%) had a diagnosis of HELLP syndrome. The values of significant biochemical parameters (mean +/- SD) were documented as ALT (alanin aminotransferase) 224 +/- 42 IU/I and ALT1 (after birth) 140 +/- 22, AST 379 +/- 23 IU/l and AST1 215 +/- 51, LDH (lactate dehydrogenase) 1418 +/- 67 IU/l and LDH1 875 +/- 16, together with the hematological parameters as platelet count (86 +/- 12 K/Ul), urine protein (3 + in urine test stick) and albumin levels (2 + 0.9 g/dl). Eighty-six (68.25%) of the patients required albumin replacement. Thirty-one (24.6%) cases were nullipara and 95 (75.4%) multipara; of which 32 women (25.4%) were in Class I, and 94 (74.6 %) in Class II of complete HELLP syndrome. Regular antenatal examination was accomplished in a very small number of patients (12.25%). Fifty-eight (46.03%) patients required transfusions with blood or blood products and 12 (9.5%) underwent laparotomy due to major intraabdominal bleeding. Magnesium sulphate to prevent convulsions and corticosteroids (12 mg betametazone) to enhance fetal lung maturity were administered. Forty-four (34.9%) cases had vaginal delivery and 82 (65.1%) cesarean section; another 18 (14.2%) were with in utero stillbirth. Fifteen babies (11.9%) died, 26 (20.63%) developed placental abruption, 14 (11.11%) acute renal insufficiency, and 13 (10.31%) postoperative subcutaneous hematomas. Maternal mortality occurred in ten cases (7.93%).
Conclusion:
HELLP syndrome is a pathology associated with a high incidence of maternal and perinatal complications. Laboratory parameters in cases with HELLP syndrome are not efficient in detecting perinatal results, but can be used as risk denominators in evaluating maternal complications. Therefore, for patients with HELLP syndrome, standard antenatal follow-up protocols should be applied in order to obtain early diagnosis and improve the speed of transfer to obstetric departments with expertise in this field.
