Publication:

HELLP syndrome and its implications on maternal and perinatal outcome

Background The HELLP syndrome is characterized by hemolysis (H), elevated liver enzymes (EL) and low platelet count (LP). This syndrome in general complicates 0.2-0.6% of all pregnancies but its incidence increases to 4-12% in severe preeclampsia. In about 15% cases, HELLP syndrome presents without definitive criteria for preeclampsia (atypical preeclampsia). This present study will throw light on incidence, clinical and biochemical profile of patients with HELLP syndrome and maternal and perinatal outcome.

Methods A prospective study was conducted in the department of Obstetrics and Gynecology, Bebe Nanki Mother and Child Care Centre, Amritsar, India from January 2016 to August 2017 after approval from institutional ethics committee.

Results In the present study, total 2949 antenatal admissions were there during the course of study. Out of these patients, 352 patients had preeclampsia-eclampsia (11.93%). Out of these 352 patients, 71 complicated with HELLP syndrome (20.17%). 17.9% had partial HELLP and 2.3% had complete HELLP syndrome. 30.16% had only EL, 31.75% had only LP, 87.3% had elevated LDH (depicted hemolysis). 4.76% had both EL and LP, 30.16% had both EL and elevated LDH, 20.63% had both LP and elevated LDH levels. Majority of the patients presented after 36 weeks of gestation. Only 5 patients had HELLP syndrome in the postpartum period. Among partial HELLP patients, 59.02% delivered vaginally and 40.98% delivered by LSCS and among complete HELLP patients 28.6% delivered vaginally and 71.4% delivered by LSCS. Perinatal mortality rate was 43.7%. Severe maternal complications such as PPH, DIC, abruptio placentae, pulmonary edema and renal failure were seen high among HELLP patients.

Conclusions As the incidence is very high, one must be aware of its clinical and laboratory findings so that early diagnosis and treatment can be initiated. Close surveillance of the mother should be continued even after delivery.