Are clinical symptoms more predictive than laboratory parameters for adverse maternal outcome in HELLP syndrome?
BACKGROUND
To determine the risk factors for adverse maternal outcome among women with HELLP syndrome.


METHODS
Sixty-one pregnancies with hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome diagnosed antenatally were reviewed between 2003 and 2005. Maternal outcomes analyzed included eclampsia, abruptio placentae, disseminated intravascular coagulopathy (DIC), acute renal failure, need for transfusion of blood products, cesarean delivery and maternal death. Risk factors included maternal age, parity, gestational age at diagnosis, mean arterial blood pressure, headache, visual changes, nausea-vomiting, epigastric pain, blood platelet count (<or=50,000 versus >50,000 cells/mm3), and peak serum levels of aspartate aminotransferase.


RESULTS
Eclampsia was present in 52%, abruptio placentae in 11%, and DIC in 8% of 61 women with HELLP syndrome. 23% women required transfusion of blood products, 15% had acute renal failure, and 73% had cesarean section. Women with eclampsia had significantly more headache, nausea-vomiting, visual changes and epigastric pain (p<0.05). Transfusion was significantly more frequent among women with blood platelet counts <or=50,000 cells/mm3 (33 versus 21%; p<0.05). Women with a platelet count <or=50,000 cells/mm3 had a higher rate of DIC compared to women with a platelet count >50,000 cells/mm3 (33.3 versus 3.8%; p<0.05). In women with acute renal failure and abruptio placentae, there were no significant differences in all the variables studied between those with and without these complications.


CONCLUSIONS
Clinical symptoms, such as headache, visual changes, epigastric pain and nausea-vomiting, are more predictive than laboratory parameters for adverse maternal outcomes.
Cavkaytar
Sabri
S
Department of Obstetrics and Gynecology, Dr. Zekai Tahir Burak Woman Health Education and Research Hospital, Ankara, Turkey. sabri99@excite.com
Ugurlu
Evin Nil
EN
Karaer
Abdullah
A
Tapisiz
Omer Lutfi
OL
Danisman
Nuri
N
D000037:Abruptio Placentae / Q000209:etiology / Q000473:pathology*; D058186:Acute Kidney Injury / Q000209:etiology / Q000473:pathology*; D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood; D004211:Disseminated Intravascular Coagulation / Q000209:etiology / Q000473:pathology*; D004461:Eclampsia / Q000209:etiology / Q000473:pathology*; D005260:Female; D005865:Gestational Age; D017359:HELLP Syndrome / Q000473:pathology* / Q000628:therapy; D006801:Humans; D010976:Platelet Count; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors
D001219:Aspartate Aminotransferases