Comparisons of maternal and perinatal outcomes in Taiwanese women with complete and partial HELLP syndrome and women with severe pre-eclampsia without HELLP.
OBJECTIVE
To analyze the variations between maternal complications and perinatal outcome among women with complete hemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome, partial HELLP syndrome, and women with severe pre-eclampsia and normal laboratory tests. We also examine the effect of corticosteroid therapy for treatment of HELLP.


METHODS
In this retrospective study, six patients with complete HELLP syndrome and 46 with partial HELLP syndrome, were compared and contrasted with 212 patients with severe pre-eclampsia but without HELLP syndrome.


RESULTS
In Protocol 1, multiple organ dysfunction syndrome (MODS) was the strongest morbidity factor associated with patients among complete HELLP, partial HELLP, and severe pre-eclampsia. After post-hoc analysis, disseminated intravascular coagulation (DIC) was the significant outcome variable between complete and partial HELLP. In Protocol 2, after adjustment, we found that MODS (adjusted OR, 15.2, 95% CI, 6.18-35.53; P < 0.001); Apgar score less than 5 at 1 minute (adjusted OR, 2.17, 95% CI, 0.94-5.01; P = 0.069) and DIC (adjusted OR, 9.51, 95% CI, 1.68-53.7, P = 0.011) remained significantly associated with HELLP syndrome. There was a favorable outcome found in the complete HELLP group. Neither the dexamethasone group nor the aggressive therapy group could benefit from the treatment protocol.


CONCLUSIONS
The different categories of HELLP syndrome, the protocol 1 and protocol 2 have been noted as differential effects on pregnancy outcome. MODS and DIC would be two significant outcome variables and corticosteroid therapy may not benefit HELLP patients.
Liu
Ching-Ming
CM
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. cliu1218.tw@yahoo.com.tw
Chang
Shuenn-Dyh
SD
Cheng
Po-Jen
PJ
Chao
An-Shine
AS
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000009:adverse effects*; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D017359:HELLP Syndrome / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D009102:Multiple Organ Failure; D011225:Pre-Eclampsia / Q000188:drug therapy* / Q000401:mortality; D011247:Pregnancy; D011255:Pregnancy Maintenance / Q000187:drug effects*; D011256:Pregnancy Outcome; D011379:Prognosis; D012189:Retrospective Studies
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone