title: Early identification of women with HELLP syndrome who need plasma exchange after delivery.
abstract: OBJECTIVE
  To compare the laboratory course of HELLP syndrome between patients who recover and those who progress to postpartum thrombotic microangiopathic syndrome (PTMS) and require postpartum plasma exchange (PPEX) and to describe maternal characteristics and morbidity in women with PTMS.
  
  
  METHODS
  In this retrospective analysis, 81 patients recovered and 5 progressed. Values for aspartate aminotransferase (AST), lactate dehydrogenase (LDH), bilirubin, platelets (Plt), urea, and creatinine at 0, 8, 16, 24, 48, and 72 hours postpartum in both groups were analyzed and compared. We also described maternal characteristics and morbidity of patients who progressed to PTMS.
  
  
  RESULTS
  Patient groups differed significantly at 72 hours postpartum for Plt and LDH values and at 24 and 48 hours for bilirubin. Trends for AST and Plt differed significantly between the recovery and progression groups in the first 48 hours. Patients who progressed had acute kidney injury and other severe maternal morbidity, including one case of maternal death.
  
  
  CONCLUSIONS
  Women with HELLP syndrome without clear Plt and AST improvement in the first 48 hours and with acute kidney injury, neurological impairment, or respiratory distress syndrome are at risk of progressing to PTMS. They should be administered PPEX between 24 and 72 hours postpartum.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava, Czech Republic; Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic. Electronic address: ondrej.simetka@fno.cz.
authors.forename: O
authors.initials: O
authors.lastname: Simetka
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava, Czech Republic; Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Klat
authors.affiliation: Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Gumulec
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava, Czech Republic.
authors.forename: E
authors.initials: E
authors.lastname: Dolezalkova
authors.affiliation: Department of Mathematical Methods in Economy, VSB-Technical University of Ostrava, Ostrava, Czech Republic.
authors.forename: D
authors.initials: D
authors.lastname: Salounova
authors.affiliation: Department of Obstetrics and Gynecology, Charles University and University Hospital, Hradec Kralove, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Kacerovsky
mesh_terms: D000328:Adult; D005260:Female; D017359:HELLP Syndrome / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D050498:Live Birth; D010951:Plasma Exchange; D049590:Postpartum Period / Q000097:blood*; D011247:Pregnancy; D011644:Puerperal Disorders / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D057049:Thrombotic Microangiopathies / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D013997:Time Factors
keywords: HELLP syndrome; Maternal morbidity; Plasmapheresis; Postpartum plasma exchange; Postpartum thrombotic microangiopathic syndrome