Clinical and biophysical aspects of HELLP-syndrome.
OBJECTIVE
The maternal-perinatal outcome and the significance of biophysical parameters in HELPP syndrome patients were evaluated.


METHODS
Sixty cases of HELLP syndrome were determined by retrospective analysis. Medical history, correlation of clinical, laboratory findings, records of fetomaternal Doppler studies, Nonstress test and maternal-perinatal outcome data were evaluated. Chi-square test was used for statistical analysis, and p < 0.05 was accepted as the significance level.


RESULTS
The incidence of HELLP syndrome in our institution was 1.03%. Mean gestational age at birth was 33.2 weeks, mean birth weight was 1861 +/- 710 g and mean umbilical pH was 7.25 +/- 0.13. Neonatal thrombocytopenia was demonstrable in 38% of neonates. Patients with low antepartal platelets (< 60,000/microliter) had a significantly higher incidence of intrauterine growth retarded fetuses than patients with higher platelet counts (p = 0.002). Doppler flow measurements were performed in 33 patients (55%). In 16 (48.4%) a pathological Doppler flow was documented. Doppler findings demonstrated very high sensitivity (83%) and specificity (80%) in predicting adverse outcome in growth retarded fetuses. In 17 patients (27%) fetal heart rate monitoring had an obvious pathologic pattern. Respiratory distress syndrome (74.4%) was the main indication for NICU admission. Perinatal mortality rate was 8.3% and neonatal mortality rate was 11.6%. Maternal morbidity rate was 30%. The most commonly observed maternal complications were abruptio placentae (n = 8), disseminated intravascular coagulation (n = 3) and severe postpartal bleeding (n = 3).


CONCLUSIONS
In HELLP syndrome patients it is very important to closely follow maternal vital signs and fluid intake and output, and to perform fetal status assessment tests. Of the biophysical parameters, Doppler flow measurement is an especially helpful predictor of poor perinatal outcome in growth retarded fetuses in HELLP patients. Patients with very low platelets have a significantly higher risk of intrauterine growth retarded fetuses.
Ertan
A Kubilay
AK
Department of Obstetrics and Gynecology, Saarland University Medical School Homburg, Germany. ertan@artemisonline.net
Wagner
Steffen
S
Hendrik
H Joachim
HJ
Tanriverdi
H Alper
HA
Schmidt
Werner
W
D000328:Adult; D001783:Blood Flow Velocity; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology; D005333:Fetus / Q000098:blood supply; D005865:Gestational Age; D017359:HELLP Syndrome / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D006340:Heart Rate, Fetal; D006801:Humans; D015994:Incidence; D017078:Laser-Doppler Flowmetry; D008499:Medical Records; D010976:Platelet Count; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis / Q000592:standards; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014421:Turkey / Q000453:epidemiology; D016216:Ultrasonography, Prenatal; D014599:Uterus / Q000098:blood supply / Q000000981:diagnostic imaging