Neonatal salvage by week's gestation in pregnancies complicated by HELLP syndrome

For clinical management and counseling purposes, we determined the neonatal salvage by weeks' gestation and birth weight of pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets).

All patients who delivered with a diagnosis of HELLP syndrome between January 1, 1980 and December 31, 1991 at a single tertiary care medical center were evaluated for neonatal outcome and survival. The syndrome was diagnosed in the presence of severe preeclampsia/eclampsia accompanied by laboratory evidence of hemolysis, hepatic dysfunction, and thrombocytopenia.

During the study interval, 58,670 live-born deliveries occurred, of which 527 (0.11%) had HELLP syndrome. In this population, 143 patients delivered fetuses at less than 30 weeks' gestational age. Based upon gestational age intervals, neonatal salvage was 0% at 23 weeks in 13 deliveries, 17% (intact salvage 8.5%) at 24 weeks, 31% (intact salvage 15%) at 25 weeks, 75% (intact salvage 65%) at 26 weeks, 80% (intact salvage 70%) at 27 weeks, and 83% at 28 and 29 weeks (intact salvage 70 and 76%). Based on birth weight intervals, neonatal salvage was 0% at less than 600 g, 34% at 600-700 g (intact salvage 17%), 69% at 700-800 g (intact salvage 53%), and 84% or more at greater than 800 g. These pregnancy outcomes are similar to those in this institution in patients without HELLP syndrome. Disease severity was distributed evenly among the 143 patients at less than 30 weeks' gestation. Apart from gestational age, there was no significant relation between the severity of the HELLP disease process and ultimate neonatal salvage.

Intact neonatal salvage in pregnancies complicated by HELLP syndrome is poor at weights less than 700 g and gestation of 25 weeks or less, but is more optimistic in pregnancies of greater than 700 g and 26 weeks' gestation or later. Aggressive efforts to enhance perinatal outcome, by operative delivery if indicated for fetal compromise, appear especially appropriate in gestations of greater than 700 g and 26 weeks' gestation or later, provided that adequate intensive care nursery facilities and neonatal expertise are available.