Are maternal and fetal parameters related to perinatal mortality in HELLP syndrome?
OBJECTIVE
We designed this retrospective study to evaluate the association between maternal and fetal parameters and perinatal mortality in hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome.


METHODS
In this retrospective study, 152 pregnancies complicated with HELLP syndrome were evaluated. Risk factors recorded were maternal age, gravidity, gestational age (weeks), systolic and diastolic blood pressure, platelet count, alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), fetal weight, and Apgar scores. The association of these factors with perinatal mortality was determined. Statistical analyses were performed using the Chi-square (χ (2)) test with Yates' correction, the Student's t test, logarithmic transformation, and the logistic regression method.


RESULTS
Ninety-two (60.52%) patients had mild preeclampsia, 46 (22.2%) had eclampsia, and 14 (15.2%) had severe preeclampsia. The fetal mortality rate was higher in eclamptic and severe preeclamptic patients (P = 0.029). No correlation was found between maternal age, laboratory values (platelet count, ALT, AST, and LDH), or systolic and diastolic blood pressure and fetal morbidity. According to the logistic regression model, fetuses with prematurity, low birth weight, and low Apgar scores (Apgar score 1 ≤ 3 and Apgar score 5 ≤ 5) were found to be at significant risk for perinatal mortality (P < 0.001). The odds ratios (95% CI) were 3.0 (2-5), 3.42 (1.82-6.41), 0.62 (0.44-0.86) and 4.66 (2.04-10.63), respectively.


CONCLUSIONS
Maternal laboratory and clinical parameters were not associated with fetal mortality. Fetal prematurity, low birth weight, and low Apgar scores were significantly associated with fetal mortality. The HELLP syndrome and severe preeclampsia may be life threatening to the mother; therefore, the accepted treatment is expeditious delivery. Our study indicates that prevention of prematurity must be the main priority for the fetus in pregnancies complicated by the HELLP syndrome. This can be efficaciously achieved using glucocorticoid therapy for lung maturity and ensuring that delivery is at an experienced hospital with a multidisciplinary approach including a neonatal intensive care unit.
Department of Obstetrics and Gynecology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey. alijnk@hotmail.com
Ali Irfan
AI
Guzel
Umur
U
Kuyumcuoglu
Yusuf
Y
Celik
D000410:Alanine Transaminase / Q000097:blood; D001034:Apgar Score; D001219:Aspartate Aminotransferases / Q000097:blood; D001794:Blood Pressure; D004461:Eclampsia / Q000097:blood / Q000401:mortality; D005260:Female; D005313:Fetal Death; D005317:Fetal Growth Retardation / Q000097:blood / Q000401:mortality; D046689:Fetal Mortality; D017359:HELLP Syndrome / Q000097:blood / Q000401:mortality*; D006461:Hemolysis; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000097:blood / Q000401:mortality; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008111:Liver Function Tests; D010976:Platelet Count; D011225:Pre-Eclampsia / Q000097:blood / Q000401:mortality; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014421:Turkey
D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase