[Management of HELLP syndrome before 32 weeks of amenorrhea. 22 cases].
OBJECTIVE
Assess expression and management of HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) occurring before 32 weeks gestation.


METHODS
Among 50 patients presenting HELLP syndrome from 1990 to 1994, 22 (44%) who developed the syndrome before 32 weeks gestation were evaluated retrospectively.


RESULTS
Most of the patients were primiparous and HELLP syndrome recurred in 2 during a second gestation before 32 weeks gestation. Only three cases began during the post partum period. All patients had severe pre-eclampsia before discovery of the HELLP syndrome. Episodes of eclampsia also occurred in 6. The most frequent clinical manifestation was epigastric pain. Ten patients had acute severe renal failure. The 3 post partum patients had severe complications (eclampsia, renal failure, subcapsular hepatic hematoma). Obstetrical intervention was required in all cases. Cesarean section was performed within 48 hours of diagnosis. Pregnancy had to be terminated in 3 cases between 24 and 29 weeks gestation. There was one fetal death in utero and one during the neonatal period. Seventeen live infants were delivered. In the group of 11 infants born after 30 weeks gestation, only 1 had hyalin membrane disease which developed in all those born before 30 weeks, including 2 with broncho-pulmonary dysplasia.


CONCLUSIONS
Based on the physiological mechanisms involved in HELLP syndrome, criteria for obstetrical extraction and the possibilities for conservative management in very premature pregnancies, we propose a management protocol for HELLP syndrome developing before 32 weeks gestation. Corticosteroid therapy may be given for 48 hours in cases without maternal or fetal complications in order to accelerate fetal maturation before extraction.
Audibert
F
F
Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Clamart.
Coffineau
A
A
Edouard
D
D
Brivet
F
F
Ville
Y
Y
Frydman
R
R
Fernandez
H
H
D000032:Abortion, Therapeutic; D000328:Adult; D002585:Cesarean Section; D004461:Eclampsia / Q000209:etiology*; D005260:Female; D017359:HELLP Syndrome / Q000150:complications*; D006801:Humans; D010996:Pleural Effusion / Q000150:complications*; D011225:Pre-Eclampsia / Q000150:complications*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic; D011261:Pregnancy Trimester, First; D051437:Renal Insufficiency / Q000150:complications*; D012128:Respiratory Distress Syndrome / Q000150:complications*; D012189:Retrospective Studies
Prise en charge du hellp syndrome avant 32 semaines d'aménorrhée. 22 observations.