DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20191968

Maternal and perinatal outcome in patients of preeclampsia with and without HELLP syndrome

Hritul Madge, Sunita Seth

Abstract


Background: Preeclampsia is seen in about 5-10% of all pregnancies and HELLP Syndrome occurs in 6-12% of these patients. Both are known to increase maternal and perinatal morbidity. The study aims to provide a comprehensive view of these myriad outcomes in the mother and neonate both, in each of the groups. It also compares the incidence of such outcomes in mother and child, in preeclampsia only and in those complicated by HELLP syndrome.

Methods: This prospective, observational, comparative study was conducted at a tertiary referral centre. 55 patients with preeclampsia were compared with 55 patients with HELLP syndrome. The relevant clinical features, laboratory investigations and the maternal and perinatal outcomes along with the incidence were studied and results analyzed.

Results: Significant differences were observed in laboratory parameters and duration of ICU stay in patients with preeclampsia and patients with HELLP syndrome. Incidence of maternal complications and need for blood transfusion was greater in HELLP syndrome. Only marginal differences were observed in birth weight, NICU admission rates and neonatal mortality rates.

Conclusions: HELLP syndrome is associated with increased maternal morbidity and mortality as compared to preeclampsia. Neonatal outcomes appear to be influenced; only marginally, by HELLP syndrome, nevertheless, their incidence is more than in preeclampsia. Aggressive treatment for pregnant women appears to decrease the maternal mortality rate.


Keywords


HELLP syndrome, Maternal and perinatal outcome, Preeclampsia

Full Text:

PDF

References


Sibai BM, Taslimi MM, El-Nazer A, Amon E, Mabie BC, Ryan GM. Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia-eclampsia. Am J Obstet Gynecol. 1986;155(3):501-8.

Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol. 1993;169(4):1000-6.

Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: A severe consequence of hypertension in pregnancy. Am J Obstet Gynecol. 1982;193(3 Pt 1):859; discussion 860.

Martin J, Rinehart BK, May WL, et al. The spectrum of severe preeclampsia: Comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification. In: Americ J Obstetr Gynecol. 1999;180(6 Pt 1):1373-84.

Tandon A, Chaudhari P, Gupta V, Ramola M. Feto-maternal outcome in patients with HELLP and partial HELLP syndrome: a prospective 10 year study in Shri Guru Ram Rai Institute of Medical and Health Sciences, Uttarakhand, India. Int J Reprod Contraception, Obstet Gynecol. 2016;5(9):3066-71.

Yildirim G, Gungorduk K, Aslan H, Gul A, Bayraktar M, Ceylan Y. Comparison of perinatal and maternal outcomes of severe preeclampsia, eclampsia, and HELLP syndrome. J Turkish Ger Gynecol Assoc. 2011;12(2):90-6.

Turgut A, Demirci O, Demirci E, Uludoğan M. Comparison of maternal and neonatal outcomes in women with HELLP syndrome and women with severe preeclampsia without HELLP syndrome. J Prenat Med. 2010;4(3):51-8.

Banoo S, Makhdoomi TA, Mir S, Malik JA. Incidence of Help syndrome in severe Pregnancy Induced Hypertension and its impact on maternal and fetal outcome. JK Pract. 2007;14(2):92-4.

Bang N, Satia M, Poonia S. Obstetric and neonatal outcome in pregnancies complicated by hemolysis elevated liver enzymes low platelet count syndrome at a tertiary care centre in India. Int J Reprod Contraception, Obstet Gynecol. 2016;2407-12.

Sep S, Verbeek J, Koek G, Smits L, Spaanderman M, Peeters L. Clinical differences between early-onset HELLP syndrome and early-onset preeclampsia during pregnancy and at least 6 months postpartum. Am J Obstet Gynecol. 2010;202(3):271.e1-5.

Van Pampus MG, Wolf H, Westenberg SM, Van Der Post JAM, Bonsel GJ, Treffers PE. Maternal and perinatal outcome after expectant management of the HELLP syndrome compared with pre-eclampsia without HELLP syndrome. Eur J Obstet Gynecol Reprod Biol. 1998;76(1):31-6.

Maged AM, Elsherief A, Hassan H, et al. Maternal, fetal, and neonatal outcomes among different types of hypertensive disorders associating pregnancy needing intensive care management. Journal of Maternal-Fetal and Neonatal Medicine. 2018;9:1-8.

Bedir Z, Ahiskalioglu A, Esenkaya, et al. HELLP syndrome is still a serious, life-Threatening complication of pregnancy: Admission of 34 women to an eastern Turkish intensive care unit. Clin Exp Obstet Gynecol. 2016;43(6):795-9.

Kota LN, Garikapati K, Kodey PD, K. B. G. Study on HELLP syndrome - maternal and perinatal outcome. Int J Reprod Contraception, Obstet Gynecol. 2017;6(2):714-9.

Kongwattanakul K, Saksiriwuttho P, Chaiyarach S, Thepsuthammarat K. Incidence, characteristics, maternal complications, and perinatal outcomes associated with preeclampsia with severe features and hellp syndrome. Int J Womens Health. 2018;10:371-7.

Ascoglu O, Güngördük K, Yildirim G, Aslan H, Günay T. Maternal and perinatal outcomes of eclampsia with and without HELLP syndrome in a teaching hospital in western Turkey. J Obstet Gynaecol (Lahore). 2014;34:326-31.

Chawla S, Marwaha A, Agarwal R. HELLP or Help: A Real Challenge. J Obstet Gynecol India. 2015;65(3)172-5.