Partial HELLP syndrome: maternal, perinatal, subsequent pregnancy and long-term maternal outcomes

Hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome, in its complete form, is associated with increased risk of maternal mortality and increased rate of serious obstetric complications, such as acute renal failure, hepatic failure, abruptio placentae, pulmonary edema, sepsis, hemorrhage and disseminated intravascular coagulopathy. To compare maternal and perinatal outcomes, we investigated the subsequent pregnancy outcomes and long-term complications of women with partial HELLP (pHELLP) and complete HELLP (cHELLP) syndromes.

In this retrospective study, patients complicated with HELLP between the years 2002 and 2007 were analyzed. cHELLP syndrome was defined by the presence of all of the three laboratory criteria according to the Tennessee Classification System. pHELLP syndrome was defined by the presence of one or two features of HELLP, but not the complete form.

Sixty-four patients had cHELLP syndrome and 67 had pHELLP syndrome. Maternal complications and neonatal outcomes of the indexed pregnancies were similar. The rate of blood product transfusion was significantly higher in the cHELLP group (P<0.0001). Twenty-eight patients within the cHELLP group and 26 within the pHELLP group had subsequent pregnancies with a mean interpregnancy interval of 2.9 ± 1.5 years and 2.4 ± 1.1 years, respectively. Elective termination of pregnancy (dilatation and curettage) was more frequent in the cHELLP group. Pre-eclampsia recurrence was higher in the pHELLP group than in the cHELLP group (7.1% vs 34.6%).

Partial and complete HELLP syndrome are not distinct groups based on neonatal, long-term and subsequent pregnancy outcomes. They probably represent a continuum in the natural evolution of the same disease.