Transactions of the Forty-Eighth Annual Meeting of the South Atlantic Association of Obstetricians and Gynecologists| Volume 155, ISSUE 3, P501-507, September 1986

Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia-eclampsia

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      During an 8-year period, 112 severe preeclamptic-eclamptic patients with the above syndrome were studied. The incidence of this syndrome was significantly higher in white patients, in patients with delayed diagnosis of preeclampsia and/or delayed delivery, and in multiparous patients. Twenty-six patients had amniocentesis and 16 received opidural anesthetics. There was one maternal bleeding episode associated with epidural anesthetics. The use of steroids in 17 patients did not improve maternal platelet count. The overall perinatal mortality was 367 per 1000 and neonatal morbidity was significant. There were two maternal deaths and two patients with ruptured liver hematoma, and nine had acute renal failure. Thirty-eight percent had intravascular coagulopathy and 20% had abruptio placentae. On follow-up, 44 patients used oral contraceptives without maternal morbidity and 38 patients had 49 subsequent pregnancies. Only one patient had recurrence of the syndrome in subsequent pregnancies. The presence of a “true” syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) in preeclampsia is associated with poor maternal-perinatal outcome.


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        • Goodlin RC
        • Cotton DB
        • Haesslein HC
        Severe edemaproteinuria-hypertension gestosis.
        Am J Obstet Gynecol. 1978; 132: 595
        • Weinstein L.
        Syndrome of hemolysis, elevated liver enzymes, and low platelet count; a severe consequence of hypertension in pregnancy.
        Am J Obstet Gynecol. 1982; 142: 159
        • Weinstein L.
        Preeclampsia/eclampsia with hemolysis, elevated liver enzymes, and thrombocytopenia.
        Obstet Gynecol. 1985; 66: 657
        • Mackenna J
        • Dover NL
        • Brame RG
        Preeclampsia associated with hemolysis, elevated liver enzymes, and low platelets—an obstetric emergency.
        Obstet Gynecol. 1983; 62: 751
        • Thiagarajah S
        • Bourgeois FJ
        • Harbert GM
        • Caudle MR
        Thrombocytopenia in preeclampsia: associated abnormalities and management principles.
        Am J Obstet Gynecol. 1984; 150: 1
        • Moodley J
        • Pillay M
        The HELLP syndrome in severe hypertensive crisis of pregnancy—does it exist?.
        S Afr Med J. 1985; 67: 246
        • Killam AP
        • Dillard SH
        • Patton RC
        • Pederson PR
        Pregnancy-induced hypertension complicated by acute liver disease and disseminated intravascular coagulation.
        Am J Obstet Gynecol. 1975; 123: 823
        • Schwartz ML
        • Brenner WE
        Pregnancy-induced hypertension presenting with life-threatening thrombocytopenia.
        Am J Obstet Gynecol. 1983; 146: 756
        • Sibai BM
        • Anderson GD
        • McCubbin JH
        Eclampsia. II. Clinical significance of laboratory findings.
        Obstet Gynecol. 1982; 59: 153
      1. Greer IA, Cameron AD, Walker JJ. HELLP syndrome: pathologic entity or technical inadequacy? Am J Obstet Gynecol 185;152:113.

        • Goodlin RC
        Beware the great imitator—severe preeclampsia.
        Contemp Ob Gyn. 1982; 20: 215
        • Brazy JE
        • Gumm JK
        • Little VA
        Neonatal manifestations of severe maternal hypertension occurring before the thirty-sixth week of pregnancy.
        J Pediatr. 1982; 100: 265
        • Pritchard JA
        • Weisman R
        • Ratnoff OD
        • et al.
        Intravascular hemolysis, thrombocytopenia and other hematologic abnormalities associated with severe toxemia of pregnancy.
        N Engl J Med. 1954; 250: 89
        • McKay DE
        Hematologic evidence of disseminated intravascular coagulation in eclampsia.
        Obstet Gynecol Surv. 1972; 27: 399
        • Beecham JB
        • Watson WJ
        • Clapp JF
        Eclampsia, preeclampsia and disseminated intravascular coagulation.
        Obstet Gynecol. 1974; 43: 576
        • Lopez-Llera M
        • Espinosa M
        • DeLeon MD
        • Linares UR
        Abnormal coagulation and fibrinolysis in eclampsia. A clinical and laboratory correlation study.
        Am J Obstet Gynecol. 1976; 124: 681