Maternal and perinatal outcome after expectant management of the HELLP syndrome compared with pre-eclampsia without HELLP syndrome

Abstract

Objective: To compare maternal and perinatal outcome of pregnancies complicated by pregnancy induced hypertension and HELLP syndrome with the outcome of pregnancies complicated by pre-eclampsia only. Design: It was a retrospective cohort study. Fifty one patients with pregnancy induced hypertension and HELLP syndrome were matched with 51 pre-eclamptic patients according to parity and gestational age on admission in hospital. Management was expectant, treatment only symptomatic and delivery was mainly effectuated because of fetal condition. Results: There was no maternal mortality in either group; maternal morbidity was more frequent in the HELLP group. Immediate intervention within a few hours of admission because of fetal distress more often occurred in the HELLP group. In both groups 41 children (80%) are still alive, with one major handicapped child in each group. Logistic regression analysis identified gestational age on admission and antihypertensive treatment on admission as significant contributors to perinatal mortality or major handicap. Whether the patient belonged to the HELLP group or the pre-eclamptic group had no influence on outcome. Conclusion: Expectant management of pregnancy induced hypertension with HELLP syndrome and pre-eclampsia without HELLP syndrome results in similar maternal and perinatal outcome. Perinatal outcome is strongly influenced by gestational age and the severity of hypertension as expressed by the need of antihypertensive treatment, irrespective of the underlying syndrome.