The spectrum of severe preeclampsia: comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification.
OBJECTIVE
This study was undertaken to explore the spectrum of maternal disease with a triple classification system of HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome and compare these classes with severe preeclampsia without HELLP syndrome.


METHODS
In this retrospective analytic study the pregnancies of 777 patients with class 1, 2, or 3 HELLP syndrome were compared and contrasted with those of 193 women with severe preeclampsia but without HELLP syndrome.


RESULTS
Eclampsia, epigastric pain, nausea and vomiting, significant proteinuria, major maternal morbidity, and stillbirth increased as HELLP syndrome worsened from class 3 to class 1. In contrast, headache and diastolic hypertension were more common among the significantly heavier patients with severe preeclampsia without HELLP syndrome. Approximately half of pregnancies complicated by class 1 HELLP syndrome exhibited significant maternal morbidity, compared with only 11% of those complicated by severe preeclampsia without HELLP syndrome. Although a significant trend was apparent in increasing levels of lactate dehydrogenase, aspartate aminotransferase, and uric acid as HELLP syndrome worsened, there was considerable variation within groups.


CONCLUSIONS
Laboratory and clinical indices of disease severity in patients with severe preeclampsia or eclampsia generally were highest with class 1 HELLP syndrome and were lowest when HELLP syndrome was absent. Class 3 HELLP syndrome is considered a clinically significant transitional group.
Martin
J N
JN
Departments of Obstetrics and Gynecology and Preventive Medicine, University of Mississippi Medical Center, Jackson, USA.
Rinehart
B K
BK
May
W L
WL
Magann
E F
EF
Terrone
D A
DA
Blake
P G
PG
D001219:Aspartate Aminotransferases / Q000097:blood; D001724:Birth Weight; D002585:Cesarean Section; D004461:Eclampsia / Q000150:complications; D005260:Female; D005313:Fetal Death; D017359:HELLP Syndrome / Q000145:classification* / Q000150:complications / Q000503:physiopathology; D006261:Headache; D006801:Humans; D006973:Hypertension; D007770:L-Lactate Dehydrogenase / Q000097:blood; D009325:Nausea; D011225:Pre-Eclampsia / Q000150:complications / Q000503:physiopathology*; D011247:Pregnancy; D011507:Proteinuria; D014527:Uric Acid / Q000097:blood; D014839:Vomiting
D014527:Uric Acid; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases