Korean J Obstet Gynecol.  1999 Sep;42(9):1903-1908.

A Clinical Experience in 16 Pregnancies with Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP Syndrome)

• Lee DM
• Kim S
• Kim HY
• Kim JY
• Choi YR
• Yoo JK
• Hwang IS

Abstract

OBJECTIVE
Our purpose was to describe the clinical progress and the maternal and fetal outcome in 16 pregnancies complicated by the HELLP(hemolysis, elevated liver enzymes, low platelet). Material: We reviewed the maternal and neonatal charts from 16 consecutive pregnancies complicated by the HELLP syndrome among 302 pregnancies complicated by preeclamsia and eclamsia managed at our hospital during the period of 4 years from June 1994 through June 1998. The HELLP syndrome was defined by previously published laboratory criteria. We assessed the time of onset, presenting symptom, laboratory finding, mode of delivery, fetal and maternal complication in each case. We also reviewed the clinical finding in detail in the case resulted in maternal death.
RESULTS
In regards to the time of onset, 15 cases (93.7%) occurred at antepartum period and only 1 case (6.2%) occurred at postpartum period. Among the 15 cases occurred at antepartum period, 13 cases (81.25%) developed at 27 to 36 weeks gestation and 2 cases (12.5%) developed at near term. In regards to the presenting symptom, twelve patients (75%) complained of right upper quardrant or epigastric pain. Of 16 patients, 12 patients (75%) experienced headache and 10 patients (62.5%) complained of nausea, or vomiting and 5 patients (31.2%) had visual disturbance. The laboratory finding of all 16 cases were as follow; the mean level of platelet: 68700/mm3 (range: 48000 to 91700), the mean level of serum asparate aminotransferase: 335 IU/L (range: 62 to 135), the mean level of lactic dehydrogenase: 910 IU/L (range: 558 to 5794), and the mean level of total bilirubin: 2.6 mg/dl (range: 0.7 to 10.4). To review the mode of delivery, cesarean sections were done on 10 patients (62.5%) including 7(43.7%) emergency and 3(18.7%) elective operations. However, 6 patients (37.5%) delivered vaginally. Maternal complications were as follow; abruptio placenta in 1 case (6.2%), DIC in 2 cases (12.5%), pulmonary edema in 3 cases (18.7%), pleural effusion in 4 cases (25%), renal failure in 4 cases (25%), and 1 case of death. Fetal and neonatal outcome was assessed; 9 cases of intrauterine growth retardation (56.2%), meconium stained in 3 cases (18.7%), 2 stillbirth (12.5%), and 2 neonatal death (12.5%).
CONCLUSION
HELLP syndrome is associated with serious maternal and fetal morbidity and mortality.

Keyword

HELLP syndrome; Preeclamsia; Eclamsia; Maternal complication; Fetal complication; HELLP

MeSH Terms

Bilirubin
Blood Platelets
Cesarean Section
Dacarbazine
Emergencies
Female
Fetal Growth Retardation
Headache
HELLP Syndrome
Hemolysis*
Humans
Liver*
Maternal Death
Meconium
Mortality
Nausea
Oxidoreductases
Placenta
Pleural Effusion
Postpartum Period
Pregnancy*
Pulmonary Edema
Renal Insufficiency
Stillbirth
Vomiting
Bilirubin
Dacarbazine
Oxidoreductases