HELLP syndrome: analysis of 23 cases

Context

HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) is a severe complication in late pregnancy. This disorder complicates between 2% and 7% of gestations and is associated with a high maternal morbidity ranging between 1% and 4%.

Objective

We undertook this study to evaluate the repercussions on maternal outcome in patients with HELLP syndrome and to determine its clinical and biological characteristics.

Design

A retrospective and analytical study.

Setting

The intensive care unit of the National Hospital of Neurology, Tunisia.

Sample

Pregnant or postdelivery women who had HELLP syndrome between January 1996 and December 2003.

Main measurements

Analysis was made of maternal age, parity, hypertension classification, gestational age at HELLP syndrome diagnosis, alterations in laboratory test for HELLP syndrome, time elapsed to discharge from hospital, maternal complications and mode of delivery.

Results

Twenty-three patients with HELLP syndrome were selected. Mean age was 33 (26–40) years. The mean gestation was 32 weeks, and 85% were delivered by caesarean section. One patient had postpartum HELLP syndrome. Hypertension was observed in all cases. Twenty-two women needed blood product transfusions. A nadir platelet count of 50,000/μl was not an independent risk factor for adverse outcome. The main complication was acute renal failure. Five patients died; three of them had a cerebral hemorrhage.

Conclusion

The high maternal morbid–mortality of HELLP syndrome requires management in a center where intensive maternal care is available.