Maternal and Perinatal Outcome in Patients with HELLP Syndrome


Affiliations

  • Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Department of Obstetrics and Gynaecology, Nashik, Maharashtra, 422003, India

Abstract

HELLP syndrome (haemolysis, elevated liver enzymes, and low platelets) is a component of hypertensive disorders of pregnancy which is associated with significant maternal as well as perinatal morbidity and mortality. Maternal mortality is due to consequences such as pulmonary oedema, renal failure, disseminated intravascular coagulation and subcapsular liver hematoma. Perinatal mortality appears to be primarily related to the gestational age at the time of delivery. This study evaluates the maternal and perinatal outcome in HELLP syndrome so that the management is improved resulting in reduced mortality and morbidity. Objectives: A. To study maternal outcome in patients diagnosed with HELLP syndrome. B. To study perinatal outcome in patients with HELLP syndrome. Methods: This study was conducted in department of obstetrics and gynaecology of medical college and tertiary health care centre. A consecutive series of 56 pregnant women above 24 weeks of gestational age with HELLP syndrome were admitted at a tertiary care hospital, during the period of 24 months from 30th November, 2015 to 31st October, 2017. History, clinical data, detailed laboratory investigations were studied and categorized by Mississippi classification for better analysis of complication and outcome in HELLP syndrome. Results: Total 56 cases of HELLP syndrome were studied. Majority of the patients were primigravidae belonging to lower socio-economic status, which were unbooked with no proper antenatal care. 60.71% of the patients had maternal complications. The complications were severe anemia in 21.43%, renal complication in 21.43%, DIC in 19.64%, abruption 14.29%, respiratory complication 7.15%, ascites 3.57% and septicemia in 3.57% and maternal mortality rate was 14.28%. A high incidence of perinatal morbidity and mortality (46.43%) was seen. Major contributing factors being prematurity, fetal growth restriction and birth asphyxia. Conclusion: HELLP syndrome is associated with increased maternal and perinatal morbidity and mortality. Once diagnosis is made, it warrants aggressive intervention with control of blood pressure, antiseizure prophylaxis and corticosteroid treatment and delivery. We have to increase grass root level antenatal care. Early detection and prompt management of pre-eclampsia is the most important approach to the prevention of HELLP syndrome.

Keywords

HELLP Syndrome, Maternal and Perinatal Outcome

Subject Discipline

Obstetrics and Gynaecology

Full Text:

References

Weinstein L. HELLP syndrome. Am J Obstet Gynecol. 1982; 9:95–111.

Sibai BM, Taslimi MM, El-Nazer A, Erol Amon, Mabie BG, Regan GM. Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes and low platelets in sever preeclampsia-eclampsia. Am J Obstet Gynecol. 1986; 155(3):501–8. https://doi.org/10.1016/00029378(86)90266-8

Sibai BM, Ramadan MK, et al. Pregnancie complicated by HELLP syndrome: Subsequent pregnancy outcome and long-term prognosis. Am J Obstet Gyneco1. 1995; 172:125–9.

Sibai BM, Ramadan MK, Usta I, et al. Maternal morbidity and mortality in 442 pregnancies with HELLP syndrome. Am J Obstet Gyneco1. 1993; 169:1000. https://doi.org/10.1016/0002-9378(93)90043-I

Gabbe SG, Niebyl JR. Joe leigh simpson obstetrics- Normal and problem pregnancies. 5th ed; 2007. p. 874–882.

Kim HY, Sohn YS, Lim JH, et al. Neonatal outcome after preterm delivery in HELLP syndrome. Yonsei Medical Journal. 2006; 47(3):393–8. https://doi.org/10.3349/ ymj.2006.47.3.393 PMid:16807990 PMCid:PMC2688160

Vigil P, Gracia D. Pregnancy complicated by preeclampsiaeclampsia with HELLP syndrome. International Journal of Gynecology and Obstetrics. 2001; 72:17–23. https://doi.org/10.1016/S0020-7292(00)00281-2

Martin JN Jr, Blake PG, Perry KG Jr, et al. The natural history of HELLP syndrome- patterns of disease progression and regression. Am J Obstet gynecol. 1991; 164:1500–13. https://doi.org/10.1016/0002-9378(91)91429-Z

Martin Jr JN, Rinehart BK, May WL, Magann EF, Terrone DA, Blake PG. The spectrum of severe preeclampsia, comparative analysis of HELLP (hemolysin, elevated liver enzymes levels and low platelet count) syndrome classification. Am J Obstet Gynecol. 1999 Jun; 180(6):1373–82. https://doi.org/10.1016/S0002-9378(99)70022-0

Ayse IMIRG, Ozdemir KOLI, Kaygusuz K, Cetin A, Cetin M, Gonullu TGM. Perinatal outcomes in HELLP syndrome. J Turkish-German Gynecol Associ. 2008; 9(2):89–93.

Amithyaa. Material and neonatal outcomes of HELLP syndrome, A 5-year retrospective analysis. Fernandez Hospital. 2010; 1(4).

Hadded B, Barton JR, Livingston TC, Chahine R, Sibai B. Risk factors for adverse material outcomes among women with HELLP (hemolysis, elevated liver enzymes and low platelet) syndrome. Am J Obstet Gynecol. 2000 Aug; 183(2):444–8. https://doi.org/10.1067/mob.2000.105915 PMid:10942484

Ahmed FA, Amin A, Naeem NK. HELLP syndrome, A clinical variant of pre- eclampsia. Annals. 2007 Apr-Jun; 13(2).

Svendson HK, Abildgaard U. The HELLP syndrome, clinical issues and management, A review. BMC Pregnancy and Child Birth. 2009; 9(8):1471–2393.

Banoo S, Makhdoomi TA, Mir S, Malik J. Incidence of HELLP syndrome in sever pregnancy induced hypertension and its impact on maternal and fetal outcome. JK Practitioner. 2007 Apr-Jun; 14(2).

Gul A, Cebeci A, Aslan H, Polat I, Ozdemivi A, Ceylan Y. Perinatal outcomes in severe preeclampsia-eclampsia with and without HELLP syndrome. Gynecol Obstet Invest. 2005; 59:113–8. https://doi.org/10.1159/000082648 PMid:15591806

Magann EF, Bass D, Chauhan SP, et al. Antipartum corticosteroids; Disease stabilization in patients with the syndrome of HELLP. Am J Obstet Gynecol. 1994; 171:1148– 53. https://doi.org/10.1016/0002-9378(94)90054-X

Visser W, Wallenburg HCS. Temporising management of severe preeclampsia with and without the HELLP syndrome. British Journal of Obstet and Gynecology. 1995 Feb; 102:111–7. https://doi.org/10.1111/j.1471-0528.1995.tb09062.x PMid:7756201


Refbacks

  • There are currently no refbacks.