Diagnosis and management of pregnancies complicated by haemolysis, elevated liver enzymes and low platelets syndrome in the tertiary setting.

Abstract

Haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome occurs in one to six per 1000 pregnancies; maternal death has been reported in 1-24% of cases. Vague presentation is common; hypertension and proteinuria which characterise pre eclampsia are often absent when HELLP syndrome presents. Physicians are often called on to review gravid patients with unexplained symptoms or abnormal laboratory results, and it is vital that these clinicians are aware of the myriad of ways in which HELLP syndrome may present and evolve. To describe the natural history of HELLP syndrome by providing contemporary data from our 8-year experience at The Royal Women's Hospital in Melbourne. A retrospective analysis of the clinical and biochemical changes presentation, natural history and outcomes for 43 women whose delivery was complicated by HELLP syndrome according to Sibai criteria. There were two stillbirths and no neonatal or maternal deaths. Most (79%) women delivered by caesarean section. Fourteen per cent were asymptomatic at diagnosis; epigastric pain was the most common presenting symptom. Hypertension was absent at presentation for more than one-third of patients. Laboratory tests showed improvement after delivery, with platelet count showing most rapid recovery postpartum. Misdiagnosis and delayed recognition of HELLP syndrome are common due to vague and varying presentation. When HELLP syndrome is identified delivery is required to avoid catastrophic maternal and neonatal outcomes. We hope to provide guidance for general and obstetric physicians by providing contemporary evidence of the presentation and clinical course of pregnancies complicated by HELLP syndrome.