title: Factors affecting maternal and perinatal outcomes in HELLP syndrome: evaluation of 126 cases.
abstract: OBJECTIVE
  To ascertain the characteristics, clinical features, and maternal fetal outcome in HELLP (hemolysis elevated liver enzymes, low platelets) syndrome at a tertiary referral center.
  
  
  METHODS
  This was a cross-sectional study carried out at Dicle University between January 2004 and December 2008 in which the charts of 126 cases were retrieved retrospectively and data analyzed descriptively.
  
  
  RESULTS
  Of all deliveries 0.9% were complicated by HELLP syndrome. Of the cases with HELLP syndrome 79 (62.6%) had preeclampsia, 28 (22.2%) had eclampsia and 19 (15.2%) had a diagnosis of HELLP syndrome. The values of significant biochemical parameters (mean +/- SD) were documented as ALT (alanin aminotransferase) 224 +/- 42 IU/I and ALT1 (after birth) 140 +/- 22, AST 379 +/- 23 IU/l and AST1 215 +/- 51, LDH (lactate dehydrogenase) 1418 +/- 67 IU/l and LDH1 875 +/- 16, together with the hematological parameters as platelet count (86 +/- 12 K/Ul), urine protein (3 + in urine test stick) and albumin levels (2 + 0.9 g/dl). Eighty-six (68.25%) of the patients required albumin replacement. Thirty-one (24.6%) cases were nullipara and 95 (75.4%) multipara; of which 32 women (25.4%) were in Class I, and 94 (74.6 %) in Class II of complete HELLP syndrome. Regular antenatal examination was accomplished in a very small number of patients (12.25%). Fifty-eight (46.03%) patients required transfusions with blood or blood products and 12 (9.5%) underwent laparotomy due to major intraabdominal bleeding. Magnesium sulphate to prevent convulsions and corticosteroids (12 mg betametazone) to enhance fetal lung maturity were administered. Forty-four (34.9%) cases had vaginal delivery and 82 (65.1%) cesarean section; another 18 (14.2%) were with in utero stillbirth. Fifteen babies (11.9%) died, 26 (20.63%) developed placental abruption, 14 (11.11%) acute renal insufficiency, and 13 (10.31%) postoperative subcutaneous hematomas. Maternal mortality occurred in ten cases (7.93%).
  
  
  CONCLUSIONS
  HELLP syndrome is a pathology associated with a high incidence of maternal and perinatal complications. Laboratory parameters in cases with HELLP syndrome are not efficient in detecting perinatal results, but can be used as risk denominators in evaluating maternal complications. Therefore, for patients with HELLP syndrome, standard antenatal follow-up protocols should be applied in order to obtain early diagnosis and improve the speed of transfer to obstetric departments with expertise in this field.
authors.affiliation: Department of Obstetrics and Gynecology, Dicle University Medical School, Diyarbakir, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Erdemoğlu
authors.forename: U
authors.initials: U
authors.lastname: Kuyumcuoğlu
authors.forename: A
authors.initials: A
authors.lastname: Kale
authors.forename: N
authors.initials: N
authors.lastname: Akdeniz
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology; D058186:Acute Kidney Injury / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001034:Apgar Score; D001623:Betamethasone / Q000627:therapeutic use; D001724:Birth Weight; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004461:Eclampsia / Q000453:epidemiology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D017359:HELLP Syndrome / Q000453:epidemiology*; D006406:Hematoma / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000196:embryology; D008278:Magnesium Sulfate / Q000627:therapeutic use; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology
chemical_list: D000927:Anticonvulsants; D005938:Glucocorticoids; D008278:Magnesium Sulfate; D001623:Betamethasone