title: Using case reports to determine when liver bleeding occurs during disease progression in HELLP syndrome.
abstract: BACKGROUND
  Hepatic hemorrhage occurs in less than 5% of patients with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome but it is a profound cause of maternal/perinatal morbidity and mortality.
  
  
  OBJECTIVE
  To determine when liver bleeding occurs during the development of HELLP syndrome.
  
  
  METHODS
  The English literature was searched for all reports of HELLP syndrome associated with liver bleeding.
  
  
  METHODS
  Eighty-seven case summaries of liver bleeding in the setting of HELLP syndrome were included. The standard definition of HELLP syndrome was used with expansion into the Mississippi classification system, supplemented by patients with partial HELLP syndrome.
  
  
  METHODS
  Demographic and clinical data were collected and recorded in an Excel database.
  
  
  RESULTS
  Liver bleeding was detected in 18 (20.7%) patients with class 1 HELLP syndrome, 24 (27.6%) with class 2 HELLP syndrome, and 12 (13.8%) with class 3 or partial HELLP syndrome. In 33 (37.9%) patients, the exact class of HELLP syndrome at the time liver bleeding was detected could not be determined from the published descriptions.
  
  
  CONCLUSIONS
  Liver bleeding can occur early during HELLP syndrome development, not only in patients with advanced, class 1 illness.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA. Electronic address: mmdarby@umc.edu.
authors.forename: Marie
authors.initials: M
authors.lastname: Darby
authors.forename: James N
authors.initials: JN
authors.lastname: Martin
authors.forename: Sarah Q
authors.initials: SQ
authors.lastname: Mitchell
authors.forename: Michelle Y
authors.initials: MY
authors.lastname: Owens
authors.forename: Kedra
authors.initials: K
authors.lastname: Wallace
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D017359:HELLP Syndrome / Q000453:epidemiology / Q000503:physiopathology*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D011247:Pregnancy; D055815:Young Adult
keywords: Dexamethasone; Hemolysis, elevated liver enzymes, low platelets; Liver hematoma; Liver rupture