781: HELLP syndrome II. Concurrent eclampsia in 70 cases

Abstract

To determine disease presentation, course and outcome in patients with HELLP syndrome alone or in conjunction with eclampsia. Two HELLP syndrome databases from a single institution, one spanning 1981-1996 (old database or ODB, n=520) and the expanded version spanning 2000-2006 (new database or NBD, n=173) were queried to identify all patients with concurrent eclampsia (E-HELLP) or without (HELLP). Only patients with complete Class 1 HELLP (platelets <50,000/uL) or Class 2 HELLP (>50,000 - <100,000/uL) syndrome with LDH>600 IU/L and AST or ALT >70 IU/L were included in the study. No eclamptic patients without complete HELLP syndrome were included in the analysis. Outcomes and laboratory data were evaluated and comparisons made between E-HELLP or HELLP in the ODB and NDB. Data were collected and analyzed by appropriate tests. Differences were considered significant if p<0.05. In the combined groups of 693 patients there were 70 patients (62 in ODB and 8 in NDB) with eclampsia (E-HELLP) and 623 without eclampsia (HELLP). Except for significantly more nulliparity in E-HELLP patients (p=0.024 in ODB), there were no demographic differences between groups. E-HELLP patients in ODB had higher admission urine protein (p=0.0474) and serum uric acid (p=0.0016, possibly due to prior seizure), lower hematocrit nadir (p=0.0287), and more red cell transfusions (p=0.0052) and plasma exchange procedures (p=0.0474) than HELLP. Other than lower systolic blood pressures at admission (p=0.0170) and at delivery (p=0.0509) than HELLP, E-HELLP patients had higher ALT levels (p=0.0384) in the NDB. Despite the relatively large size of the study groups, we were unable to detect in either data set a significant worsening of maternal or perinatal outcome in E-HELLP patients compared to HELLP alone. Eclampsia does not appear to contribute a significant adverse impact upon the course or outcome of complete HELLP syndrome pregnancies.