Hellp Syndrome, A Clincial Variant of Pre-Eclampsia

Abstract

Objective: of study the incidence and effects of complications on maternal and perinatal outcome in pregnancies complicated by HELLP syndrome in severe pre-eclampsia/eclampsia. Material and Method: Retrospective survey of case records of 156 (1.17%) women admitted with pre-eclampsia/eclampsia during last 2 years (March 2005 -march 2007) in department of Obstetrics and Gynaecology, Fatima Memorial Hospital, Lahore was done. Results: The incidence of severe pre-eclampsia/eclampsia was 1.17% (156/13336). Primigravidas constituted 44 and multigravidas 112. HELLP syndrome occurred in 6 primigravidas (13.63%) and 10 multigravidas (8.92%). Maternal deaths were 6.2% (1/16) in HELLP syndrome. Serious maternal morbidity in HELLP syndrome was abruptio placentae (25%), disseminated intravascular coagulation (62.5%), acute renal failure (18.75% of whom 33.3% needed haemodialysis) and postpartum hemorrhage (12.5%). Eighty women developed postpartum eclampsia, three developed adult respiratory distress syndrome. None had cerebral vascular thrombosis. Admissions to intensive care unit were 10, though none of patients required ventilator support. The perinatal mortality was 68.75% (11/16). The overall perinatal morbidity and neonatal ICU admissions were also significant. Conclusion: HLLP syndrome is associated with increase in maternal and perinatal mortality & morbidity. The importance lies in early diagnosis, direct input by clinician with special expertise in the management. So the perinatal mortality and morbidity can be brought down with early reference to tertiary care level hospital. Keywords: Maternal morbidity, perinatal mortality, HELLP syndrome, severe pre-eclampsia, eclampsia.