Maternal mortality associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.
OBJECTIVE
The aim of this study was to determine factors contributing to deaths among women with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.


METHODS
Information from multiple sources was scrutinized to distinguish and profile maternal deaths associated with HELLP syndrome.


RESULTS
Information was available regarding 54 maternal deaths. According to HELLP syndrome classification 60.0% had class 1 disease, 35.6% had class 2 disease, and 4.4% had class 3 disease. Events associated with maternal deaths included cerebral hemorrhage (45%), cardiopulmonary arrest (40%), disseminated intravascular coagulopathy (39%), adult respiratory distress syndrome (28%), renal failure (28%), sepsis (23%), hepatic hemorrhage (20%), and hypoxic ischemic encephalopathy (16%). Delay in diagnosis of HELLP syndrome was implicated in 22 of 43 patients' deaths (51.1%).


CONCLUSIONS
It appears that (1) most maternal deaths occurred among women with class 1 HELLP syndrome, (2) delay in diagnosis was associated with mortal consequences, and (3) hemorrhage in the hepatic or central nervous system or vascular insult to the cardiopulmonary or renal system were associated with increased mortality risk.
Isler
C M
CM
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA.
Rinehart
B K
BK
Terrone
D A
DA
Martin
R W
RW
Magann
E F
EF
Martin
J N
JN
D000328:Adult; D002543:Cerebral Hemorrhage / Q000401:mortality; D004211:Disseminated Intravascular Coagulation / Q000401:mortality; D005260:Female; D005865:Gestational Age; D017359:HELLP Syndrome / Q000175:diagnosis / Q000401:mortality*; D006323:Heart Arrest / Q000401:mortality; D006470:Hemorrhage / Q000401:mortality; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000401:mortality; D007231:Infant, Newborn; D008107:Liver Diseases / Q000401:mortality; D011247:Pregnancy; D051437:Renal Insufficiency / Q000401:mortality; D012127:Respiratory Distress Syndrome, Newborn / Q000401:mortality; D018805:Sepsis / Q000401:mortality; D013997:Time Factors