DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20202722

Fetomaternal outcome in pregnancy with HELLP syndrome

Prachi M. Shelat, Rupa C. Vyas, Sapana R. Shah, Naimish D. Nathwani

Abstract


Background: HELLP Syndrome is a serious complication of pregnancy induced hypertensive disorders. It is defined as a triad of hemolysis, elevated liver enzymes, and low platelet count (HELLP). Objectives of this study was to find out incidence of HELLP syndrome in pre-eclampsia, eclampsia and its overall incidence. To analyse the clinical profile of HELLP syndrome. To study maternal and perinatal outcome including morbidity and mortality.

Methods: A retrospective study was conducted from July 2017 to September 2019 at a tertiary care center with inclusion criteria of abnormal peripheral blood smear, elevated liver enzymes (LDH, aspartate aminotransferase), and low platelet count.

Results: HELLP syndrome was more common in younger age group (45%) and in primigravida (52.5%). Most of the patients presented at >36 weeks of gestation (40%) and most of the patients delivered by caesarean section (67.5%). Maternal complications were acute renal failure (27.5%), DIC (22.5%), maternal mortality (7.5%). Neonatal complications associated were intrauterine death (27.5%), prematurity (25%) and intrauterine growth retardation (15%).

Conclusions: Thus, HELLP syndrome requires an early diagnosis and early initiation of treatment at tertiary care center with all the medical facilities available.


Keywords


Elevated liver enzymes, Hemolysis, Low platelets, Thrombocytopenia

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References


Litchman, M, Kipps T, Seligsohn U, Kaushansky K, Prchal J. Thrombocytopenia. Williams Hematology, Eighth Edition. Mcgraw-Hill Companies; 2010:119.

Knerr I, Beinder E, Rascher W. Syncytin, a novel human endogenous retroviral gene in human placenta: Evidence for its dysregulation in preeclampsia and HELLP syndrome. Am J Obstet Gynecol. 2002;186:210.

Levine RJ, Maynard SE, Qian C, Lim KH, England LJ, Yu KF, et al. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med. 2004;350:672.

Mutter WP, Karumanchi SA. Molecular mechanism of preeclampsia. Microvasc Res. 2008;75:1.

Widmer M, Villar J, Benigni A, Conde-Agudelo A, Karumanchi SA, Lindheimer M. Mapping the theories of preeclampsia and the role of angiogenic factors: a systematic review. Obstet Gynecol. 2007;109(1):168-80.

Semenovskaya Z, Erogul M. Pregnancy, preeclampsia. Medscape Reference; 2011.

Zhou Y, McMaster M, Woo K, Janatpour M, Perry J, Karpanen T, et al. Vascular endothelial growth factor ligands and receptors that regulate human cytotrophoblast survival are dysregulated in severe preeclampsia and hemolysis, elevated liver enzymes and low platelets syndrome. Am J Pathol. 2002;160:1405-23.

Strand S, Strand D. Placenta-derived CD59 ligand causes liver damage in haemolysis, elevated liver enzymes and low platelet count syndrome. Gastroenterol. 2004;126:849-58.

Fang C, Richards A, Liszewski MK, Kavanagh D, Atkinson JP. Advances in understanding in pathogenesis of aHUS and HELLP. BJH British J Hematol. 2008;143:336-48.

Sibai BM. The HELLP syndrome (hemolysis, elevated liver enzymes and low platelets): much ado about nothing? Am J Obstet Gynecol. 1990;162:311-6.

Chhabra S, Qureshi A, Datta N. Prevalence of HELLP syndrome in gestational hypertension in India. J Obstet Gynecol. 2006;26(6):531-3.

Rahman TM, Wendon J. Severe hepatic dysfunction in pregnancy. Q J Med. 2002;95:343.

Padden MO. HELLP syndrome: recognition and perinatal management. Am Family Phys. 1999;60(3):829.

Harms K, Rath W, Herting E, Kuhn W. Maternal hemolysis, elevated liver enzymes, low platelet count and neonatal outcome. Am J Perinatol. 1995;12:93.

Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Am J Obstet Gynecol. 2004;103:981-91.

Martin JN, Magann EF, Blake PG. Analysis of 454 pregnancies with severe preeclampsia, eclampsia, HELLP syndrome using the 3class system of classification. Am J Gynecol. 1993;168:386.

Lakshmi NK, Kavitha G, Prabha Devi K, Gayathri KB. Study on HELLP syndrome-maternal and perinatal outcome. Int J Reprod Contracept Obstet Gynecol. 2017;6:714-9.

Durugkar K, Bal H, Agrawal S. A study of maternal and perinatal outcome in cases of HELLP and partial HELLP syndrome. Int J Reprod Contracept Obstet Gynecol. 2017;6:5491-6.

Kaur AP, Kaur N, Dhillon SPS. HELLP syndrome and its implications on maternal and perinatal outcome. Int J Reprod Contracept Obstet Gynecol. 2018;7:1007-11.

George P, Thankachi VJ. Hellp syndrome-a study from a tertiary centre in India. J Contemp Med Res. 2017;4(7):1604-6.

İmir GA, Kol Öİ, Kaygusuz K, Çetin A, Çetin M, Güvenal T, Gönüllü M. Perinatal outcomes in HELLP syndrome. J Turkish-German Gynecol Associ. 2008;9(2):89-93.

Vigil P, Gracia D. Pregnancy complicated by preeclampsia, eclampsia with HELLP Syndrome. Inte J Gynecol Obstet. 2001;72:17-23.