Prediction of HELLP syndrome with assessment of maternal dual hepatic blood supply by using Doppler ultrasound.
OBJECTIVE
Early structural and functional changes in the systemic vasculature have been proposed to play a major pathogenetic role in HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Our objective was to assess whether the evaluation of maternal hepatic blood supply is instructive to the prediction of onset of HELLP syndrome.


METHODS
Prospective observation study.


METHODS
Fifty-eight women with severe preeclampsia and 60 healthy pregnant controls at 25-36 weeks gestation.


METHODS
Angle-corrected time-averaged flow velocity and the cross-sectional area of common hepatic artery and portal vein were measured by using Doppler ultrasonography in 58 women with severe preeclampsia and in 60 healthy pregnant controls at 25-36 weeks gestation. Intravascular flow volumes were calculated from the product of the time-averaged velocity and the cross-sectional area. The total liver blood flow was taken as the sum of flow volumes in the hepatic artery and portal vein.


RESULTS
The total liver blood flow decreased significantly to about 40% of control in 9 women with severe preeclampsia who developed HELLP syndrome within 4 days after the examination, but not in 49 women with severe preeclampsia without HELLP syndrome.


CONCLUSIONS
The results indicated that the decrease in dual hepatic blood supply preceded the onset of HELLP syndrome.
Kawabata
Ikuno
I
Department of Obstetrics and Gynecology, Tama Nagayama Hospital, Nippon Medical School, 1-7-1 Nagayama, Tama-City, Tokyo 206-8512, Japan.
Nakai
Akihito
A
Takeshita
Toshiyuki
T