Maternal and Perinatal Outcome in Patients with HELLP Syndrome

Abstract

HELLP syndrome (haemolysis, elevated liver enzymes, and low platelets) is a component of hypertensive disorders of pregnancy which is associated with significant maternal as well as perinatal morbidity and mortality. Maternal mortality is due to consequences such as pulmonary oedema, renal failure, disseminated intravascular coagulation and subcapsular liver hematoma. Perinatal mortality appears to be primarily related to the gestational age at the time of delivery. This study evaluates the maternal and perinatal outcome in HELLP syndrome so that the management is improved resulting in reduced mortality and morbidity. Objectives: A. To study maternal outcome in patients diagnosed with HELLP syndrome. B. To study perinatal outcome in patients with HELLP syndrome. Methods: This study was conducted in department of obstetrics and gynaecology of medical college and tertiary health care centre. A consecutive series of 56 pregnant women above 24 weeks of gestational age with HELLP syndrome were admitted at a tertiary care hospital, during the period of 24 months from 30th November, 2015 to 31st October, 2017. History, clinical data, detailed laboratory investigations were studied and categorized by Mississippi classification for better analysis of complication and outcome in HELLP syndrome. Results: Total 56 cases of HELLP syndrome were studied. Majority of the patients were primigravidae belonging to lower socio-economic status, which were unbooked with no proper antenatal care. 60.71% of the patients had maternal complications. The complications were severe anemia in 21.43%, renal complication in 21.43%, DIC in 19.64%, abruption 14.29%, respiratory complication 7.15%, ascites 3.57% and septicemia in 3.57% and maternal mortality rate was 14.28%. A high incidence of perinatal morbidity and mortality (46.43%) was seen. Major contributing factors being prematurity, fetal growth restriction and birth asphyxia. Conclusion: HELLP syndrome is associated with increased maternal and perinatal morbidity and mortality. Once diagnosis is made, it warrants aggressive intervention with control of blood pressure, antiseizure prophylaxis and corticosteroid treatment and delivery. We have to increase grass root level antenatal care. Early detection and prompt management of pre-eclampsia is the most important approach to the prevention of HELLP syndrome.