HELLP Syndrome with and without Eclampsia

ABSTRACT

We assessed pregnancy outcomes for patients with HELLP syndrome (hemolysis; elevated liver enzymes; low platelet count) with and without concurrent eclampsia. We performed a retrospective investigation of data spanning three decades of patients with class 1 or 2 HELLP syndrome with concurrent eclampsia (HELLP + E) and patients with HELLP syndrome without eclampsia. Data were analyzed by appropriate tests for continuous or categorical outcomes with differences considered significant if p < 0.05. During 1981 to 1996 and 2000 to 2006, there were 693 patients with class 1 or 2 HELLP syndrome; altogether, 70 patients had HELLP + E. The only demographic difference was greater nulliparity in HELLP + E patients. Otherwise, inconsistent and clinically insignificant differences were observed between groups. Despite the relatively large size of the study groups, we were unable to detect a significant worsening of maternal or perinatal outcome in HELLP + E patients compared with HELLP patients. In our experience, eclampsia does not appear to contribute a significant adverse impact upon the course or outcome of HELLP syndrome pregnancies.

KEYWORDS

Eclampsia - HELLP syndrome - severe preeclampsia

REFERENCES

• 1 Martin Jr J N, Rose C H, Briery C M. Understanding and managing HELLP syndrome: the integral role of aggressive glucocorticoids for mother and child.  Am J Obstet Gynecol. 2006;  195 914-934
• 2 Sibai B M. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count.  Obstet Gynecol. 2004;  103 (5 Pt 1) 981-991
• 3 Martin Jr J N, Perry Jr K G, Miles J F et al.. The interrelationship of eclampsia, HELLP syndrome, and prematurity: cofactors for significant maternal and perinatal risk.  BJOG. 1993;  100 1095-1100
• 4 Vigil-De Gracia P. Pregnancy complicated by pre-eclampsia-eclampsia with HELLP syndrome.  Int J Gynaecol Obstet. 2001;  72 17-23
• 5 Conde-Agudelo A, Kafury-Goeta A C. Case-control study of risk factors for complicated eclampsia.  Obstet Gynecol. 1997;  90 172-175
• 6 Katz V L, Farmer R, Kuller J A. Preeclampsia into eclampsia: toward a new paradigm.  Am J Obstet Gynecol. 2000;  182 1389-1396
• 7 Andersgaard A B, Herbst A, Johansen M et al.. Eclampsia in Scandinavia: incidence, substandard care, and potentially preventable cases.  Acta Obstet Gynecol Scand. 2006;  85 929-936
• 8 Demir S C, Evruke C, Ozgunen F T, Urunsak I F, Candan E, Kadayifci O. Factors that influence morbidity and mortality in severe preeclampsia, eclampsia and hemolysis, elevated liver enzymes, and low platelet count syndrome.  Saudi Med J. 2006;  27 1015-1018
• 9 Miguil M, Chekairi A. Eclampsia, study of 342 cases.  Hypertens Pregnancy. 2008;  27 103-111
• 10 Douglas K A, Redman C WG. Eclampsia in the United Kingdom.  BMJ. 1994;  309 1395-1400
• 11 Sibai B M, Ramadan M K, Usta I, Salama M, Mercer B M, Friedman S A. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome).  Am J Obstet Gynecol. 1993;  169 1000-1006
• 12 Martin Jr J N, Rinehart B K, May W L, Magann E F, Terrone D A, Blake P G. The spectrum of severe preeclampsia: comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification.  Am J Obstet Gynecol. 1999;  180 (6 Pt 1) 1373-1384
• 13 Aagaard-Tillery K M, Belfort M A. Eclampsia: morbidity, mortality, and management.  Clin Obstet Gynecol. 2005;  48 12-23
• 14 Sibai B M, Stella C L. Diagnosis and management of atypical preeclampsia-eclampsia.  Am J Obstet Gynecol. 2009;  200 481.e1-481.e7
• 15 Sibai B M, Eclampsia V I. Eclampsia. VI. Maternal-perinatal outcome in 254 consecutive cases.  Am J Obstet Gynecol. 1990;  163 1049-1054 discussion 1054-1055
• 16 Martin Jr J N, Thigpen B D, Moore R C, Rose C H, Cushman J, May W L. Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure.  Obstet Gynecol. 2005;  105 246-254
• 17 Martin Jr J N, Owens M Y, Parrish M R, Tam Tam K B, Brewer J M, Cushman J L, May W L. Standardized treatment of 190 consecutive patients with HELLP syndrome using the Mississippi Protocol: no maternal death, stroke or liver rupture. Hypertens Pregnancy in progress
• 18 Mattar F, Sibai B M. Eclampsia. VIII. Risk factors for maternal morbidity.  Am J Obstet Gynecol. 2000;  182 307-312
• 19 Maharaj A S, Walshe T E, Saint-Geniez M et al.. VEGF and TGF-beta are required for the maintenance of the choroid plexus and ependyma.  J Exp Med. 2008;  205 491-501
• 20 Makinde O N, Adegoke O A, Adediran I A et al.. HELLP syndrome: the experience at Ile-Ife, Nigeria.  J Obstet Gynaecol. 2009;  29 195-199
• 21 Vigil-De Gracia P. Maternal deaths due to eclampsia and HELLP syndrome.  Int J Gynaecol Obstet. 2009;  104 90-94