Acute renal failure in pregnancies complicated by hemolysis, elevated liver enzymes, and low platelets

Our purpose was to describe maternal-perinatal outcome, subsequent pregnancy outcome, and long-term prognosis after hemolysis, elevated liver enzymes, and low platelets and acute renal failure.

Thirty-two patients with this complication were studied in the index pregnancy and were subsequently followed for an average of 4.5 years. Six patients had preexisting hypertension, and 26 were normotensive during the index pregnancy.

There were four maternal deaths (13%), 27 (84%) had disseminated intravascular coagulation, 14 (44%) had pulmonary edema, and 10 (31%) required dialysis. The perinatal mortality rate was 34%, and 72% of births were preterm. Eight normotensive women had 11 subsequent pregnancies, only one complicated by preeclampsia. Four hypertensive women had six subsequent pregnancies; three were complicated by severe preeclampsia and fetal death (one complicated by hemolysis, elevated liver enzymes, and low platelets and one by renal failure). None of 23 surviving normotensive women had residual renal damage or hypertension on follow-up, whereas two of five hypertensive women required chronic dialysis.

These findings should be used in counseling these patients regarding the index pregnancy and future pregnancies.