PII: S0002-9378(96)70130-8

Abstract

We thank Kurzel et al. for their interest in our work. They present Doppler velocimetry measurements of the hepatic artery, the branches of the portal vein, and of hepatic vein in six patients with the HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome compared with six normal controls. Doppler velocimetry in the patients with HELLP syndrome was performed 2 days post partum. In contrast to our findings, they did not find a difference in the resistance index of the hepatic artery. A major difference between the two studies is that Kurzel et al. performed Doppler velocimetry 2 days post partum, which means during the recovery phase of the disease. In our study we demonstrated that both in preeclampsia and in the HELLP syndrome hepatic vascular resistance is increased. We also found that in the HELLP syndrome vasoconstriction in the hepatic arteries is not more pronounced than in preeclampsia without HELLP. Therefore, from the results of our study, we concluded that it is unlikely that excessive vasoconstriction in the hepatic arteries plays an important role in the development of HELLP syndrome. This was supported by our observation that no relationship could be demonstrated between abnormal liver function tests and hepatic artery pulsatility index values. Although the differences were not significant, Kurzel et al. consistently report lower mean velocities in the portal vein branches of patients with HELLP syndrome. They suggest that a diminished portal flow primarily underlies the observed hepatic injury seen in HELLP syndrome. Their observation could well fit with our conclusion that other factors besides vasoconstriction have to be involved in the development of HELLP syndrome.1Aarnoudse JG Houthoff HJ Weits J Vellinga G Huisjes HJ A syndrome of liver damage and intravascular coagulation in the last trimester of normotensive pregnancy. a clinical and histopathological study.Br J Obstet Gynaecol. 1986; 93: 145-155Crossref PubMed Scopus (140) Google Scholar Unfortunately, Kurzel et al. do not report whether there was a relationship between mean portal vein branch velocities and abnormal liver function test results. We agree with the authors that further Doppler studies in pregnancies complicated by the HELLP syndrome are needed, to elucidate the circulatory disturbances in the liver and the resulting hepatic injury in the HELLP syndrome. 6/8/77871 In the article by Menczer et al., entitled "The effect of diagnosis and treatment delay on prognostic factors and survival in endometrial carcinoma" (Am J Obstet Gynecol 1995;173:774-8), in the list of authors on page 744 "Jeffrey Gaylor, PhD," should have been "Jeffrey Gaynor, PhD."