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The interrelationship of eclampsia, HELLP syndrome, and prematurity: cofactors for significant maternal and perinatal
J N Martin1, K G Perry, J F Miles
1Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505.
Objective:
To determine if there are differences between mothers and fetuses in eclamptic pregnancies with or without concurrent HELLP syndrome.
Design:
Retrospective review.
Setting:
A single tertiary perinatal centre, the University of Mississippi Medical Center.
Subjects:
All eclamptic pregnancies treated during a 141 month period from 1980 until the end of 1991.
Methods:
Pregnancies were grouped according to the presence or absence of HELLP syndrome subclassified as class 1 = platelet nadir < or = 50,000/microliters, class 2 = platelet nadir > 50,000 to < or = 100,000/microliters, and class 3 = platelet nadir > 100,000 to < or = 150,000/microliters.
Results:
Among 49,782 live births, there were 117 women with eclampsia prior to delivery (incidence 1:425), 62 of which had HELLP syndrome. The group with HELLP syndrome were delivered significantly earlier (32.1 vs 36.4 weeks), and had lower birthweights (1821 vs 2550 grams) and higher perinatal mortality (113 vs 18:100). They were also transfused more frequently (65% vs 35%), and suffered greater overall serious maternal morbidity and mortality.
Conclusion:
Eclampsia is more likely to be associated with the HELLP syndrome at early gestations. Although eclamptic patients are already at risk, the presence of HELLP syndrome accentuates the risk for adverse maternal-perinatal outcome.