title: The HELLP syndrome (hemolysis, elevated liver enzymes and low platelets): Clinical characteristics and maternal-fetal outcome in 172 patients.
abstract: OBJECTIVE
  To analyze the frequency of the different clinical presentations of the disease in women with HELLP syndrome and the most important factors that can predict a different maternal and fetal outcome.
  
  
  METHODS
  This is a cross-sectional, consecutive, case-series study, the subjects being all patients with HELLP syndrome admitted to our Hospital within the last decade (1999-2009).
  
  
  RESULTS
  The rate of maternal complications was 43.0% and perinatal mortality 14.1%. The severity of the syndrome, measured by The Mississippi Classification, influenced the rate of maternal complications but not fetal mortality: the rate of maternal complications among women in class 1 HELLP syndrome was 67.6%, compared to 49.3% in class 2 and 24.0% in class 3 HELLP syndrome, p<0.0001. In a 21.8% of women, the onset of the disease was after delivery. We highlight the fact that those cases with an early puerperium onset of the disease were those with a higher number of maternal complications (odds ratio: 2.38; CI: 1.05-5.44).
  
  
  CONCLUSIONS
  These results suggest the possibility of an increased complication rate when the onset of the syndrome appears after delivery and the necessity of having a high grade of suspicion in every case to diagnose the disease, even when the gestation and delivery were normal.
authors.affiliation: Vascular Risk Unit, Service of Internal Medicine, IBIS, Hospital Universitario Virgen del Rocío, SAS, Universidad de Sevilla, CSIC, Avda. Manuel Siurot s/n, 41013 Seville, Spain.
authors.forename: M L
authors.initials: ML
authors.lastname: Miranda
authors.affiliation: Vascular Risk Unit, Service of Internal Medicine, IBIS, Hospital Universitario Virgen del Rocío, SAS, Universidad de Sevilla, CSIC, Avda. Manuel Siurot s/n, 41013 Seville, Spain.
authors.forename: A J
authors.initials: AJ
authors.lastname: Vallejo-Vaz
authors.affiliation: Service of Obstetrics and Gynecology, Hospital Universitario Virgen del Rocío, SAS, Avda. Manuel Siurot s/n, 41013 Seville, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Cerrillo
authors.affiliation: Service of Anaesthesia, Hospital Universitario Virgen del Rocío, SAS, Avda. Manuel Siurot s/n, 41013 Seville, Spain.
authors.forename: M L
authors.initials: ML
authors.lastname: Marenco
authors.affiliation: Vascular Risk Unit, Service of Internal Medicine, IBIS, Hospital Universitario Virgen del Rocío, SAS, Universidad de Sevilla, CSIC, Avda. Manuel Siurot s/n, 41013 Seville, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Villar
authors.affiliation: Vascular Risk Unit, Service of Internal Medicine, IBIS, Hospital Universitario Virgen del Rocío, SAS, Universidad de Sevilla, CSIC, Avda. Manuel Siurot s/n, 41013 Seville, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Stiefel