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HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome versus

severe preeclampsia: Onset at <=28.0 weeks' gestation.


General Obstetrics and Gynecology
American Journal of Obstetrics & Gynecology. 183(6):1475-1479, December 2000.
Haddad, Bassam MD a; Barton, John R. MD b; Livingston, Jeffrey C. MD a; Chahine,
Rabih MD a; Sibai, Baha M. MD c
Abstract:
Objective: Our purpose was to determine whether the onset of the HELLP (hemolysis,
elevated liver enzymes, and low platelet count) syndrome in women at <=28.0 weeks'
gestation is associated with an increased risk of adverse maternal and perinatal outcomes
in comparison with the risk for women with severe preeclampsia but without the HELLP
syndrome at a similar gestational age.
Study Design: Sixty-four patients with either the HELLP syndrome (n = 32) or severe
preeclampsia but absent HELLP syndrome laboratory test results (n = 32), admitted at
<=28.0 weeks' gestation between July 1, 1992, and April 30, 1999, were studied.
Maternal and perinatal outcomes were compared between the 2 groups. Statistical
analysis was performed by the Student t test and the Fisher exact test.
Results: There were no significant differences between the 2 groups regarding AfricanAmerican race (59% vs 75%), nulliparity (50% vs 56%), or the use of corticosteroids
(59% vs 78%). There were no maternal deaths. One woman with the HELLP syndrome
had a liver hematoma. The rate at which transfusion of blood products was required was
significantly greater in women with the HELLP syndrome than in those with severe
preeclampsia only (25% vs 3%;P < .05). There were no significant differences between
the 2 groups with respect to eclampsia (16% vs 13%), abruptio placentae (6% vs 9%),
disseminated intravascular coagulopathy (13% vs 0%), pulmonary edema (13% vs 6%),
acute renal failure (3% vs 0%), pleural effusion (3% vs 3%), or ascites (6% vs 16%). No
significant differences were found between the 2 groups with respect to neonatal death
(11% vs 17%), respiratory distress syndrome (78% vs 86%), or composite neonatal
morbidity.
Conclusions: Except for the need for transfusion of blood products in women with the
HELLP syndrome, onset at <=28.0 weeks' gestation is not associated with an increased
risk of adverse maternal or neonatal outcomes in comparison with the risk for women
with severe preeclampsia but without the HELLP syndrome at a similar gestational age.
(Am J Obstet Gynecol 2000;183:1475-9.)
(C) Mosby-Year Book Inc. 2000. All Rights Reserved.
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Obstetrics & Gynecology 1989;73:97-102


1989 by The American College of Obstetricians and Gynecologists
Disseminated intravascular coagulation and the syndrome of hemolysis, elevated
liver enzymes, and low platelets in severe preeclampsia
PA Van Dam, M Renier, M Baekelandt, P Buytaert, and F Uyttenbroeck
To clarify the role of disseminated intravascular coagulation (DIC) in women with the
hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, serial
coagulation studies were performed prospectively in 18 patients. A semiquantitative DIC
scoring system was used retrospectively to augment the diagnostic confidence of
coagulopathy. At the time of admission to the hospital, three patients showed no evidence
of DIC, eight had suspected DIC, and seven had manifest DIC. The intravascular
coagulation process was progressive in all patients; upon delivery, eight patients proved
to have suspected DIC and ten had manifest DIC. The laboratory criteria of DIC were
found to agree with the degree of organ dysfunction. Patients with manifest DIC at
delivery developed significantly more life-threatening maternal complications than did
patients with suspected DIC (P less than .02). Conservative management was not possible
in any patients who were admitted with overt DIC because of deterioration of maternal
and fetal status. Application of a sensitive DIC scoring system may be valuable in
managing patients with the HELLP syndrome and selecting patients who may be treated
expectantly.
http://www.greenjournal.org/cgi/content/abstract/73/1/97
Clinical analysis of six cases with hemolysis,elevated liver enzymes and low platelet
count syndrome
WANG Yu-ping, FENG Cui-ping, CHEN Qing-yun Department of Obstetrics
and Gynecology,China-Japan Friendship Hospital,Beijing 100029,
ChinaAbstract:ObjectiveTo analyze the clinical character,diagnosis,treatment and
prognosis of patients with hemolysis,elevated liver enzymes and low platelet count
HELLP syndrome.MethodsThe clinical data of six cases with HELLP syndrome
were analyzed retrospectively during the past twelve years.ResultsThere were four
cases with complete HELLP syndrome and two cases with partial HELLP syndrome.4
cases had special characters such as abdominal pain or discomfort in top right part;teacolor urine etc.Two cases had no sign of hypertension complicating pregnancy.The major
complications were disseminated intravascular coagulation, cerebral hemorrhage
companied with hydrocephalus,acute renal failure and placental abruption.Three maternal
deaths were attributed to severe complications.Two perinatal deaths were related to
abrnption placenta and intrauterine asphyxia.ConclusionHELLP syndrome is a severe
life threatening disease,which has high maternal and perinatal mortality.So it should be
identified by its special characters and diagnosed as fast as possible.The severe patient
should be treated with termination of pregnancy as soon as possible and prevention of
severe complications.[]
Key words:pregnancy complications,cardiovascular;HELLP syndrome

2006 20 5
JOURNAL OF CHINA-JAPAN FRIENDSHIP HOSPITAL 274-277
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