Abstract
HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) syndrome is a severe and rapidly progressing condition that requires distinct diagnostic considerations. The aim of this study was to evaluate the impact of the Mississippi triple-class system on the HELLP syndrome diagnosis, treatment, and outcomes in a perinatology centre during a 10-year period, and consider its effectiveness and necessity in everyday practice. A retrospective observational cohort study was carried out using the medical records of a tertiary perinatology centre with the diagnosis of HELLP syndrome from the period of time between 2005 and 2014. The patients who fit the HELLP syndrome diagnosis were grouped by the Mississippi triple-class system. The means of diagnosis and treatment outcomes within those groups were analysed statistically. There was insufficient statistical evidence of the blood pressure levels corresponding to the severity of patients’ condition (p > 0.05 in all of the groups). The clinical presentation varied within all of the classes, and the only objective means of diagnosis and evaluation of progression of the condition were laboratory tests. Even though HELLP syndrome is considered a hypertensive multi-organ disorder of pregnancy, the level of hypertension does not correlate to the severity of the condition; hence, the diagnosis should be based on biochemical laboratory evidence. Vigilance in suspicion and the recognition of HELLP syndrome and appropriate treatment are essential in order to ensure better maternal and neonatal outcomes.
Highlights
Hypertensive disorders of pregnancy complicate up to 10% of pregnancies and constitute one of the major causes of maternal and perinatal morbidity and mortality worldwide [1]
HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) syndrome is a potentially life-threatening condition manifesting in the context of preeclampsia, which poses challenging diagnostic and management issues to the clinician [2]
Following a detailed review of those records, 11 (17.19%) of parturients were excluded from the study, as they did not meet the criteria for HELLP nor partial HELLP syndrome diagnosis
Summary
Hypertensive disorders of pregnancy complicate up to 10% of pregnancies and constitute one of the major causes of maternal and perinatal morbidity and mortality worldwide [1]. HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) syndrome is a potentially life-threatening condition manifesting in the context of preeclampsia, which poses challenging diagnostic and management issues to the clinician [2]. Two major guidelines are used for HELLP syndrome diagnosis based on haemolysis, elevated liver enzymes, and low platelet (PLT) count, namely, the Tennessee classification and Mississippi triple-class system. According to the Mississippi triple-class system, the severity of HELLP syndrome is mostly characterised by the amount of PLT (Table 1) [3,4]. There is still a limited number of studies that would reveal the impact of the guideline application in everyday practice. There is very limited observational data on the effect that the diagnostics and management approach has on the outcome on a larger scale.
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