Partial HELLP Syndrome
maternal and perinatal outcome
Keywords:
HELLP syndrome, Partial HELLP Syndrome, Preeclampsia, Maternal outcome, Perinatal outcomeAbstract
CONTEXT: HELLP syndrome is a severe complication of pregnancy characterized by hemolysis, elevated liver enzymes and low platelet count. Some pregnant women develop just one or two of the characteristics of this syndrome, which is termed Partial HELLP Syndrome (PHS). OBJECTIVE: The objective of this study was to evaluate the repercussions on maternal and perinatal outcomes among women that developed PHS and to compare these women with those whose gestational hypertension or preeclampsia did not show alterations for HELLP syndrome in laboratory tests. DESIGN: Observational, retrospective and analytical study. SETTING: Maternity Department of Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil. SAMPLE: Pregnant or post-delivery women who had a blood pressure elevation that was first detected after mid-pregnancy, with or without proteinuria, between January 1990 and December 1995. MAIN MEASUREMENTS: Analysis was made of maternal age, race, parity, hypertension classification, gestational age at the PHS diagnosis, alterations in laboratory tests for HELLP syndrome, time elapsed to discharge from hospital, maternal complications, mode of delivery, incidence of preterm birth, intrauterine growth restriction, stillborn and neonatal death. RESULTS: Three hundred and eighteen women were selected; forty-one women (12.9%) had PHS and 277 of them (87.1%) did not develop any of the alterations of the HELLP syndrome diagnosis. Preeclampsia was a more frequent type of hypertension in the PHS group than in the hypertension group. None of the women with isolated chronic hypertension developed PHS. The rate of cesarean delivery, eclampsia, and preterm delivery was significantly greater in the PHS group than in the hypertension group. CONCLUSION: We observed that aggressive procedures had been adopted for patients with PHS. These resulted in immediate interruption of pregnancy, with elevated cesarean rates and preterm delivery. Such decisions need to be reviewed, in order to reduce the cesarean rate and the incidence of preterm delivery.
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References
Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol 1982;142:159-67.
Sibai BM. The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): much ado about nothing? Am J Obstet Gynecol 1990;162:311-6.
Oosterhof H, Voorhoeve PG, Aarnoudse JG. Enhancement of hepatic artery resistance to blood flow in preeclampsia in pres- ence or absence of HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). Am J Obstet Gynecol 1994;171:526-30.
Tsatsaris V, Carbonne B, Dupré La Tour M, Cabrol D, Milliez J. Is conservative treatment of HELLP syndrome safe? Eur J Obstet Gynecol Reprod Biol 1997;80:139-41.
O’Boyle JD, Magann EF, Waxman E, Martin JN. Dexametha- sone-facilitated postponement of delivery of an extremely preterm pregnancy complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelets. Mil Med 1999;164:316-8.
Martin JN, Rinehart BK, May WL, Magann EF, Terrone DA, Blake PG. The spectrum of severe preeclampsia: comparative analysis by HELLP (hemolysis, elevated liver enzymes levels, and low platelet count) syndrome classification. Am J Obstet Gynecol 1999;180:1373-84.
Martin JN, Blake PG, Lowry SL, Perry KG, Files JC, Morrison JC. Pregnancy complicated by preeclampsia-eclampsia with syn- drome of hemolysis, elevated liver enzymes, and low platelet count: how rapid is postpartum recovery? Obstet Gynecol 1990;76:737-41.
MacKenna J, Dover NL, Brame RG. Preeclampsia associated with hemolysis, elevated liver enzymes, and low platelets an obstetric emergency? Obstet Gynecol 1983;62:751-4.
Van Dam PA, Renier M, Baekelandt M, Buytaert P, Uyttenbroeck F. Disseminated intravascular coagulation and the syndrome of hemolysis, elevated liver enzymes, and low plate- lets in severe preeclampsia. Obstet Gynecol 1989;73:97-102.
Goodlin RC. Beware the great imitator severe preeclampsia. Contemp Ob Gyn 1982;20:215-9.
Thiagarajah S, Bourgeois FJ, Harbert GM, Caudle MR. Throm- bocytopenia in preeclampsia: associated abnormalities and man- agement principles. Am J Obstet Gynecol 1984;150:1-7.
Brazy JE, Grimm JK, Little VA. Neonatal manifestations of severe maternal hypertension occurring before the thirty-sixth week of pregnancy. J Pediatr 1982;100:265-71.
van Pampus MG, Wolf H, Westenberg SM, van der Post JA, Bonsel GJ, Treffers PE. Maternal and perinatal outcome after expectant management of the HELLP syndrome compared with preeclampsia without HELLP syndrome. Eur J Obstet Gynecol Reprod Biol 1998;76:31-6.
Aarnoudse JG, Houthoff HJ, Weits J, Vellenga E, Huisjes HJ. A syndrome of liver damage and intravascular coagulation in the last trimester of normotensive pregnancy. A clinical and histopathological study. Br J Obstet Gynaecol 1986;93:145- 55.
Audibert F, Friedman AS, Frangieh AY, Sibai BM. Clinical util- ity of strict diagnostic criteria for the HELLP (hemolysis, el- evated liver enzymes, and low platelets) syndrome. Am J Obstet Gynecol 1996;175:460-4.
Roberts WE, Perry KG, Woods JB, Files JC, Blake PG, Martin JN. The intrapartum platelet count in patients with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome: is it predictive of later hemorrhagic complications? Am J Obstet Gynecol 1994;171:799-804.
Takiuti NH, Kahhale S, Carrara W, Alves EA, Zugaib M. Síndrome HELLP Resultados materno-fetais. Rev Latinam Perinatol 1994;14:13-9.
Williams KP, Wilson S. Ethnic variation in the incidence of HELLP syndrome in a hypertensive pregnant population. J Perinat Med 1997;25:498-501.
Santos LC, Cardoso MP, Carvalho MA, Porto AMF, Azevedo EB, Mesquita C. HELLP síndrome. GO Atual 1997;10:20-9.
Marchioli M. Repercussões maternas e perinatais relacionadas à classificação da hipertensão arterial na gravidez [MSc disserta- tion]. Botucatu (SP): Faculdade de Medicina da Universidade Estadual Paulista; 1999.
Parpinelli MA, Silva JLP, Pereira BG, Amaral E, Rodrigues F, Torres JCC. Distúrbio hipertensivo na gravidez acompanhado por síndrome HELLP. Rev Bras Ginecol Obstet 1994;16:129-34.
Abramovici D, Friedman SA, Mercer BM, Audibert F, Kao L, Sibai BM. Neonatal outcome in severe preeclampsia at 24 to 36 weeks’ gestation: Does the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome matter? Am J Obstet Gynecol 1999;180:221-5.
Martin JN, Blake PG, Perry KG, McCaul JF, Hess LW, Martin RW. The natural history of HELLP syndrome: patterns of dis- ease progression and regression. Am J Obstet Gynecol 1991;164:1500-13.
National High Blood Pressure Education Program. Working Group Report on High Blood Pressure in Pregnancy. National Institutes of Health Publication no. 00-302, originally printed 1990, revised 2000. Washington: National Institutes of Health, 2000.
Assemblea Médica Mundial – Declaración de Helsinki. Recomendaciones para guiar a los médicos en la investigación biomédica en seres humanos. Bol Of Sanit Panam 1990;108:626-9.
Schmorl G. Pathologisch-anatomische untersuchungen über puerperal eklampsia. Leipzig: FCW Vogel, 1893.
Magann EF, Martin JN. Twelve steps to optimal management of HELLP syndrome. Clin Obstet Gynecol 1999;42:532-50.
Sibai BM, Spinnato JA, Watson DL, Hill GA, Anderson GD. Pregnancy outcome in 303 cases with severe preeclampsia. Obstet Gynecol 1984;64:319-25.
Rey E, Couturier A. The prognosis of pregnancy in women with chronic hypertension. Am J Obstet Gynecol 1994;171:410-6.
Omu AE, al-Othman S, al-Falah FZ, Sharma P. A comparative study of obstetric outcome of patients with pregnancy induced hypertension: economic considerations. Acta Obst Gynecol Scand 1996;75:443-8.
Jain L. Effect of pregnancy-induced and chronic hypertensions on pregnancy outcome. J Perinatol 1997;17:425-7.
Hartikainen A, Aliharm RH, Rantakallio PT. A cohort stud of epidemiological associations and outcomes of pregnancies with hypertensive disorders. Hipertens Pregnancy 1998;17:31-41.
Modema MAB. Hipertensão arterial na gravidez: aspectos perinatais [MSc dissertation]. Sorocaba (SP): Pontifícia Universidade Católica; 1993.
Vasconcellos MJA, Ritto MNG, Oliveira ILC, Louro EP, Rocco R. Resultados do protocolo de acompanhamento da gestante hipertensa. Rev Ginecol Obstet 1994;5:22-8.
Alves EA. Estudo propectivo, comparativo da isradipina e atenolol no tratamento de gestantes hipertensas [PhD thesis]. São Paulo (SP): Universidade de São Paulo; 1998.
