HELLP Syndrome Group Research Articles

Clinical Study of HELLP Syndrome and It's Outcome at Pravara Rural Hospital, Loni

Background: HELLP syndrome, a severe pregnancy complication characterized by hemolysis, elevated liver enzymes, and low platelet count, occurs in 0.5 to 0.9% of all pregnancies and in 10–20% of severe preeclampsia cases. It poses significant risks to both mother and fetus, presenting diagnostic and therapeutic challenges. Patients often experience epigastric or right upper quadrant pain, hypertension, proteinuria, fatigue, nausea, vomiting, sudden weight gain, and headaches. HELLP syndrome typically occurs in the second and third trimesters (27-37 weeks) and 15–30% of cases present postpartum. The exact causes remain unclear but may involve placental origins, autoimmune factors, gene mutations, or fatty acid oxidation disorders. Aims and Objectives: To analyze the clinical profile of HELLP syndrome cases and to assess maternal and perinatal outcomes, including morbidity and mortality. Material and Methods: This prospective cross-sectional study was conducted in the Obstetrics and Gynecology department at Pravara Rural Hospital, Loni, involving 45 patients with severe preeclampsia and eclampsia above 28 weeks of gestation diagnosed with HELLP syndrome. Patients were admitted to the ICU, and detailed histories and examinations were recorded. Patients were divided into two groups: those with HELLP syndrome (Group A) and those without (Group B). Results: Group A had a higher representation in the 20-22 age bracket, while Group B had more members aged 22-24. Cesarean sections were more common in Group A, whereas vaginal deliveries were more frequent in Group B. Blood pressure readings were higher in Group A. Maternal complications, such as abruption placentae, DIC, hepatic infarction, acute renal failure, and ascites, were more frequent in Group A, as were neonatal complications like IUGR, preterm delivery, neonatal thrombocytopenia, and RDS. Conclusion: The study reveals significant differences between patients with and without HELLP syndrome. Group A included younger patients, more first-time mothers, and a higher incidence of complications and mortality. These findings highlight the need for tailored management strategies for severe preeclampsia/eclampsia, especially in those with HELLP syndrome, to improve maternal and neonatal outcomes.

Can SIRI or other inflammatory indices predict HELLP syndrome in the first trimester?

ObjectiveTo investigate the use of systemic immune-response index (SIRI) and other inflammatory indices for the prediction of HELLP syndrome Study designThe presented retrospective case-control study was conducted with twenty-eight pregnant women diagnosed with HELLP syndrome and 100 low-risk pregnant women. The possible predictive indices for HELLP syndrome were determined as NLR (neutrophil/lymphocyte), MLR (monocyte/lymphocyte), HbLR (hemoglobin/lymphocyte), SII (neutrophil×platelet/lymphocyte), and SIRI (neutrophil×monocyte/lymphocyte). The indices were evaluated in the first trimester and at the admission time for delivery for all participants. The statistical analyses were carried out using SPSS 23. Descriptive statistics were presented as the mean and standard deviation (SD), as they conform to a normal distribution. To compare the parameters between the groups, the Student-t test was used. Categorical variables were presented as numbers and percentages. The chi-square test was used to compare categorical variables between groups. The paired sample t-test was used to compare correlated samples. Statistical significance was defined as a two-tailed P value of 0.05. ResultsIn the first trimester; WBC, neutrophil, and monocyte counts were statistically higher in the HELLP syndrome group. However, no significant difference was observed between the groups for the concerned indices. The hemoglobin, WBC, neutrophil, monocyte counts, NLR, SIRI and MLR were significantly higher in the HELLP group at the delivery time. Platelet count was decreased and ALT/AST counts and adverse outcomes were found to be significantly higher at delivery time admission in the HELLP syndrome group. ConclusionTo the best of our knowledge, this was the first study investigating SIRI with the other indices for the prediction of HELLP syndrome in accordance with its inflammatory etiology. The underlying inflammatory process was observed at the delivery time. However, none of the investigated indices was found effective in the first trimester in the prediction. Simple and non-invasive prediction indices might be valuable tools for the prediction and management of HELLP syndrome. Further and larger studies are needed for this purpose.

Correlation of Neutrophil Lymphocyte Ration (NLR) Values with Severe Preeclampsia, HELLP Syndrome, and Eclampsia

Background: Preeclampsia (PE) is the leading cause of maternal and fetal morbidity and mortality. The disease is characterized by hypertension (≥140/90 mmHg), proteinuria, thrombocytopenia, renal failure, neurological complications, liver involvement, and fetal growth retardation. HELLP syndrome is a variant of preeclampsia that causes an increase in liver enzymes and a low platelet count. Eclampsia is the heaviest complication of preeclampsia. Neutrophil lymphocyte ratio (NLR) is part of the leukocyte type count examination which is an easy, available examination parameter and can be used as an index of the severity of systemic inflammation. This study aimed to determine the relationship of neutrophil-lymphocyte ratio (NLR) values with severe Preeclampsia, HELLP syndrome, and eclampsia.Method: This research is a comparative analytical study with a case control study approach. This research was conducted from April-November 2022. This study was conducted at the emergency room (ER) and inpatient department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Andalas – RSUP Dr. M. Djamil Padang. The study sample was part of the population that met the inclusion and exclusion criteria. The study required 108 samples, namely 27 from the severe preeclampsia group, 27 from the eclampsia group, 27 from the HELLP syndrome group, and 27 from the control group. Bivariate statistical analysis using Independent T-Test. Samples were taken by the method of consecutive sampling. The data were analyzed at a 95% confidence interval, if obtained p value<0.05 then there is a significant relationship. The Data was analyzed by the SPSS computer program.Results: The results of this study obtained neutrophil-lymphocyte ratio in eclampsia has the highest average value compared with HELLP syndrome, severe preeclampsia, and control. While HELLP syndrome has a higher mean value than severe preeclampsia and control and subsequently severe preeclampsia also has a higher mean value NLR than control. This study found a significant relationship between neutrophil-lymphocyte ratio (NLR) with severe Preeclampsia, HELLP syndrome, and eclampsia (all p values=0.000).Conclusion: This study proves that neutrophil-lymphocyte ratio (NLR) has a significant relationship with severe Preeclampsia, HELLP syndrome, and eclampsia so further research can develop this study by analyzing other factors that affect preeclampsia. For clinicians can make this study as a reference in monitoring the progression of inflammation that occurs in severe preeclampsia, HELLP syndrome, and eclampsia.

The role of haptoglobin in the diagnosis of preeclampsia and HELLP syndrome and in predicting neonatal outcomes.

The study aimed to determine whether maternal serum haptoglobin values could have an effect on predicting diagnosis and neonatal outcomes in preeclampsia and HELLP syndrome. Hundred sixteen pregnant women who met the inclusion criteria were included in the study. To evaluate whether serum haptoglobin level in maternal blood could be used in early diagnosis of preeclampsia and HELLP syndrome, 49 pregnant women diagnosed with preeclampsia and 13 pregnant women diagnosed with HELLP syndrome were included in the study group, and 54 healthy pregnant women in the control group. The groups were compared regarding maternal serum haptoglobin level, platelet count, ALT, AST, LDH, and uric acid levels. Moreover, the age, obstetric histories, and newborn outcomes of all pregnant women were recorded and compared between groups. The mean haptoglobin values were 0.29 ± 0.23 g/L in the HELLP syndrome group, 1.01 ± 0.52 g/L in the preeclampsia group, and 1.16 ± 0.37 g/L in the control group. The mean haptoglobin result was lower in the HELLP syndrome group compared to the preeclampsia and control groups (p < 0.001). While the differences between HELLP syndrome and the control and preeclampsia groups were statistically significant, no significant difference was determined between the preeclampsia and control groups. There was a significant positive correlation between haptoglobin value with the week of delivery, umbilical cord pH value, and the first and fifth-minute Apgar scores (p < 0.05). It was concluded that haptoglobin values could be used together with other biochemical parameters to diagnose HELLP syndrome and predict newborn outcomes.

Comparison of clinical features in antepartum and postpartum HELLP syndrome

Objective: To analyze the clinical features and pregnancy outcomes in antepartum and postpartum hemolysis, elevated live enzymes, and low platelet count syndrome(HELLP syndrome). Methods: A retrospective study was conducted to collect maternal and neonatal information of pre-eclampsia complicated with HELLP syndrome in Peking University First Hospital during the ten years from April 2009 to March 2019. A total of 83 pregnant women were included according to the Tennessee Classification System. They were then allocated into two groups based on the onset time of HELLP syndrome: antepartum HELLP syndrome group (n=70) and postpartum HELLP syndrome group (n=13). The clinical features, symptoms, laboratory biomarkers, and pregnancy outcomes were compared between the two groups. Results: Among the 83 pregnant women with HELLP syndrome, 70 occurred prenatally (84%, 70/83) and 13 occurred postpartum (16%, 13/83). The twin or triplet pregnancy rate in the postpartum HELLP syndrome group was significantly higher than that in the antepartum HELLP syndrome group [6/13 vs 6% (4/70), P=0.001]. The gestational weeks for HELLP onset and delivery in the postpartum HELLP syndrome group were significantly later than those in the antepartum HELLP syndrome group [(35.8±3.0) vs (31.5±5.2) weeks, P=0.025; (36.7±2.3) vs (32.2±5.0) weeks, P=0.002]. The incidence of early-onset pre-eclampsia in the antepartum HELLP syndrome group was significant higher than that in the postpartum HELLP syndrome group [64% (45/70) vs 2/13, P=0.002]. The quantitative of 24-hour proteinuria was significant higher in the antepartum HELLP syndrome group than that in the postpartum HELLP syndrome group [(4.8±5.1) vs (1.8±1.6) g, P=0.002]. But there were no statistical significances in the comparison of other laboratory test indexes (all P>0.05). There were no significant differences between the two groups in clinical symptoms, severe maternal complications, transfusion or adverse maternal outcomes (all P>0.05). Conclusions: Antepartum and postpartum HELLP syndrome have similar clinical symptoms and laboratory characteristics. Both antepartum and postpartum HELLP syndrome could lead to severe maternal complications, which should be paid special attention in clinical practice, especially to the postpartum HELLP syndrome.

Serum MUC3 Protein as a Novel Marker of Gestational Hypertensive Disorders.

This study aimed to investigate the serum levels of mucoprotein 3 in hypertensive diseases of pregnancy. In total, 60 consecutive women with gestational hypertensive diseases (gestational hypertension (n = 20), severe preeclampsia (n = 20), HELLP syndrome (n = 20)) and 20 pregnant women without any gestational hypertensive diseases were included for this prospective controlled study. Serum MUC3 protein levels were measured with commercially available ELISA kits. Serum MUC3 protein level was the lowest in normal pregnant women (0.1047 ± 0.0295ng/ml); while the severity of the disease increases, it significantly increased in severe preeclampsia (0.2700 ± 0.0199ng/mL) and HELLP syndrome group (0.3494 ± 0.0455ng/mL), but less in the gestational hypertension (0.2172 ± 0.0354ng/mL) group. Mean serum MUC3 protein level differences were found the least in gestational hypertension (0.1125 ± 0.0107, p < 0.001), the most in HELLP syndrome (-0.2546 ± 0.0107, p < 0.001) compared with the pregnant control group. The increase in serum MUC3 protein concentration in these women supported the argument that serum MUC3 protein may be used as a marker indicating the severity of the gestational hypertensive diseases.

Features of nephropathy in various types of thrombotic microagniopathies in obstetric practice

Introduction. We assessed the features of kidney injury in patients with different types of TMA during pregnancy, taking into consideration the fact that the acute kidney injury (AKI) that occurs during pregnancy or in the early postpartum period is main- ly caused by various types of thrombotic microangiopathies (TMA), and AKI itself is a serious obstetric complication with the risk of serious complications and mortality for both mother and fetus.Objective of the study. To study the features of nephropathy in different types of pregnancy-associated TMA.Materials and methods. The study included 313 pregnant women, women in childbirth and puerperas, of which 71 women had atypical hemolytic uremic syndrome (aHUS), 124 – HELLP syndrome, 70 – varying degrees of severity of PE, a group of patients with more rare causes of TMA was also identified: TTP, CAPS and sepsis (13 patients) and 45 patients for the control group. We assessed and compared the main clinical, laboratory and instrumental data, and assessed the outcome of labour. Also, histological examination of the kidneys was performed in five patients with aHUS.Results and discussion. The results of the study have shown that the most severe manifestations of TMA in the form of target organ injury and nephropathy are usually occur in patients with aHUS, where all women developed AKI, in some cases with the formation of chronic kidney disease. In the HELLP syndrome group, AKI was recorded in 39%, but renal function quickly restored. It was found that the very fact of the presence of AKI points to a more unfavourable prognosis not only for the patients themselves, but also for the child, being the main risk factor for perinatal death. The findings of urinary sediment tests and morphological evaluation indicate that the resulting ischemia of the renal tissue in cases of aHUS, HELLP syndrome and other types of TMA can lead to tubular necrosis as compared with PE. Our results suggest that it is AKI in HELLP syndrome that is the main risk factor for perinatal death. Alas, this relationship is difficult to trace in patients with aHUS, as all of them had AKI.Conclusions. Timely recognition of the AKI phenomenon in all cases of obstetric TMA can reduce the risks for both mother and fetus. Both the prognosis for mother and the prognosis for child depend on AKI, and timely therapy can lead to a regression of AKI phenomena and the complete restoration of renal function.

Angiogenic profiling in HELLP syndrome cases with or without hypertension and proteinuria

ObjectivesAngiogenic profiling with the use of sFlt-1/PlGF ratio (soluble fms-like tyrosine kinase-1/placental growth factor) can be helpful to characterize women with signs of impending preeclampsia (PE). However, little is known about the angiogenic profile of pregnancies complicated by HELLP syndrome. The aim of this study was to examine the relationship of angiogenic profiles in cases of HELLP syndrome with and without classical signs of preeclampsia. Study designThe angiogenic profile of pregnant women with singleton gestation and isolated PE (group 1), PE associated with HELLP syndrome (group 2), and isolated HELLP syndrome (group 3) from 01/2011 to 03/2018, were compared. To overcome gestational age dependent angiogenic behavior, cases (group 3) were matched 1:2 with cases from group 1 and 2. Matching criteria was gestational age (±1 week). PE and HELLP syndrome were defined according to the international Society for the Study of Hypertension in Pregnancy (ISSHP) statement 2014. ResultsDuring the observational period, 244 women could be included in the study. Of those, 237 (97.1%) were diagnosed with PE. In 42 cases (17.2%) PE was associated with HELLP syndrome while 7 (2.9%) patients were diagnosed with isolated HELLP syndrome. Angiogenic profiles in terms of sFlt-1/PlGF ratios differed significantly between the three groups, showing highest levels in group 2 (PE/HELLP) while cases with isolated HELLP demonstrated the lowest ratios and sFlt-1 values (p = 0.01). ConclusionWe conclude that isolated HELLP syndrome is rare and seems to be a particular entity expressing a different angiogenic behaviour compared to classical PE or PE associated with HELLP syndrome.

Incidence, characteristics, maternal complications, and perinatal outcomes associated with preeclampsia with severe features and HELLP syndrome.

ObjectiveTo determine the incidence of preeclampsia with severe features among pregnant women and evaluate the characteristics, maternal complications, and perinatal outcomes between nonsevere preeclampsia versus preeclampsia with severe features and hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome.Materials and methodsA retrospective descriptive study was conducted at Khon Kaen University’s Srinagarind Hospital, a tertiary care facility in northeast Thailand. The pregnant women who had been diagnosed with preeclampsia according to American College of Obstetricians and Gynecologists guidelines from January 1, 2012 to December 31, 2016 were identified and their medical records were reviewed. Various characteristics were examined to compare maternal complications and perinatal outcomes.ResultsThere was a total of 11,199 deliveries during the study period, out of which 213 preeclamptic women were identified. One hundred and seven women (9.6 per 1,000 deliveries) were diagnosed with nonsevere preeclampsia, 90 (8 per 1,000 deliveries) had preeclampsia with severe features, and 16 (1.4 per 1,000 deliveries) had HELLP syndrome. Twenty-one women (9.9%) experienced postpartum hemorrhage; 11 (10.3%) in the nonsevere features preeclampsia group and 10 (9.4%) in the preeclampsia with severe features and HELLP syndrome group. Placental abruption (3 women; 1.4%) and heart failure (1 women; 0.4%) only occurred among women in the preeclampsia with severe features group. Neonatal complications were significantly higher in the preeclampsia with severe features and HELLP syndrome group (low birth weight =35.1% versus 74.3%, p<0.001; birth asphyxia =4.4% versus 18.2%, p=0.001; neonatal intensive care unit admission =7.0% versus 30.9%, p<0.001; neonatal resuscitation =15.8% versus 42.7%, p<0.001). Stillbirths only occurred in cases of preeclampsia with severe features and HELLP syndrome (3 cases, 1.4%). Intrapartum death was higher in cases of preeclampsia with severe features and HELLP syndrome, but without statistical significance (2.6% versus 6.4%, p=0.190).ConclusionThe incidence of preeclampsia with severe features and HELLP syndrome was 9.5 per 1,000 deliveries. Severe maternal and perinatal outcomes were more commonly observed.

Effect of raised serum uric acid level on perinatal and maternal outcome in cases of pregnancy-induced hypertension

The aim of this study was to find out the effects of raised serum uric acid level on perinatal and maternal outcome in cases of pregnancy-induced hypertension. One hundred pregnant women with gestational period beyond 28 weeks with pregnancy-induced hypertension-preeclampsia and eclampsia were included in this study and divided into two groups. Group A (n=65) patients with a serum uric acid level &gt;6 mg/dL was compared to Group B (n=35) patients with a uric acid level &lt;6 gm/dL. It revealed that high uric acid level in patients with pregnancy-induced hypertension was a risk factor for several maternal complications like postpartum hemorrhage (Group A, 12 cases; Group B, 7 cases), postpartum eclampsia (Group A, 7 cases; Group B, 3 cases), abruptio placentae (Group A, 6 cases; Group B, 2 cases), HELLP syndrome (Group A, 2 cases; Group B, no case) and pulmonary edema (Group A, 3 cases; Group B, no case). In case of perinatal outcome, the birth weight, intrauterine growth retardation, intrauterine death, stillbirth and neonatal death rate were worse in Group A 1.9 kg, 46, 19, 7 and 8 cases in comparison to Group B, where those were 2.1, 13, 6, 2, and 2 cases respectively. In conclusion, high uric acid in blood in patient with hypertensive disorders in pregnancy is a risk factor for several maternal complications.

EARLY DETECTION OF HELLP SYNDROME USING BIOLOGICAL MARKERS AND DOPPLER ULTRASONOGRAPHY

Purpose: To determine the relationship between pregnancy-associated plasma protein-A (PAPP-A) levels and uterine Doppler ultrasonography for the prediction of severe preeclampsia (PE) and HELLP syndrome at the last trimester. Methods: Two groups were constructed; severe preeclampsia group consisted of 38 women; HELLP Syndrome group consisted of 12 women. Both groups were matched strictly for gestational age at last trimester. Maternal blood sample for PAPP-A was collected and uterine Doppler ultrasonography was performed as soon as any woman under the study was diagnosed as severe preeclampsia or HELLP syndrome at last trimester and compared. Results: Mean ages of participants, Parity, gestational weeks and fetal weights were similar. Mean PAPP-A levels were significantly higher in severe preeclampsia and HELLP groups. There was a statistically significant difference regarding Resistive Index (RI) (P<0.001) and Pulsatility Index (PI) (P=0.005) between cases presenting with severe preeclampsia and HELLP groups. Conclusion: PAPP-A levels could provide prediction for severe preeclampsia and HELLP syndrome at last trimester. Increased uterine artery resistance in the third trimester of pregnancy could be used to predict maternal complications including severe preeclampsia and HELLP syndrome.

Clinical characteristics and outcomes of severe preeclampsia concurrent HELLP syndrome admitted in the intensive care unit

Objective To determine the characteristics and outcome of the severe preeclampsia patients concurrent HELLP syndrome admitted in intensive care unit(ICU). Methods Patients with severe preeclampsia admitted were identified and divided into the two groups according to with or without HELLP syndrome. The characteristics, organ function, treatment and outcome were compared between two groups. Results Of 61 severe preeclampsia patients,18 patients were diagnosed HELLP syndrome(18/61,29.51%). Compared with patients without HELLP syndrome, the age, rate of regular prenatal care and emergency cesarean section were significantly different in patients with HELLP syndrome[(30.56±4.11)vs(30.02±6.00);11% vs 59%;60.5% vs 94.4% respectively,t= 5.563,χ2 = 4.155,7.043,all P< 0.05].Lactate dehydrogenase and total bilirubin were significantly higher in patients with HELLP syndrome[(1 398.94±1 587.49)U/L vs(561.75±304.84)U/L,(33.48±48.86)μmol/L vs(9.70±7.18) μmol/ L,t= 14.717,7.53,all P<0.05].The platelet was obviously lower in patients with HELLPsyndrome[(49.56± 27.14)×109/L vs(207.93±116.68)×109/L,t= 20.762,P< 0.05].There was one patient died in each group and the mortality rate was not different between two groups.In HELLPsyndrome group,2 patients developed acute kidney injury and received renal replacement treatment,which was significantly higher than group without HELLP syndrome (11% vs 0%,χ2= 4.94,P< 0.05). There were more patients accepted transfusion in severe preeclampsia with HELLP syndrome group(61.1% vs 30.2%,χ2= 5.07,P< 0.05). Conclusion The incidence of concurrent severe preeclampsia and HELLP syndrome is not rare for critically ill obstetric patients. The rate of organ dysfunction is high in patients with HELLP syndrome. Key words: Pre-Eclampsia; HELLP Syndrome; Pregnancy Outcome; Intensive Care Unit

Distribution of sugar residues in human placentas from pregnancies complicated by hypertensive disorders

The aim of the study was to investigate the content and distribution of sugar residues in placentas from pregnancies complicated by hypertensive disorders. Placentas from women with uncomplicated pregnancies (group 1), pregnancies complicated by gestational hypertension (group 2), pregnancies complicated by pre-eclampsia (group 3), pregnancies complicated by pre-eclampsia with HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) (group 4) were collected. Lectins: ConA, WGA, PNA, SBA, DBA, UEA I, GNA, DSA, MAA, SNA, in combination with chemical and enzymatic treatments, were used. Data showed a decrease and/or lack of α- d-mannose, α- d-glucose and d-galactose-(β1-4)-N-acetyl- d-glucosamine in placentas from pre-eclampsia and pre-eclampsia with HELLP syndrome compared with control and hypertension cases. N-acetyl- d-galactosamine appeared and/or increased in placentas from hypertensive disorders. A different distribution of various types of sialic acid was observed in placentas from hypertensive disorders compared with the controls. In particular, placentas from pre-eclampsia, with and without HELLP syndrome, lacked the acetylated sialic acid side-chain. These findings demonstrate various alterations of the carbohydrate metabolism in the placentas from pregnancies complicated by different types of hypertensive disorders. This indicates correlation with the placental morpho-functional changes characteristic of these complications and with the degree of clinical severity.

T14.5 HELLP syndrome: does postpartum dexamethasone improve maternal outcome?

them were concurrent eclampsia and HELLP syndrome. We analyzed the characteristics (age, gestational weeks, death rate of maternal, the need for mechanical ventilation, the rate for ICU admittion, GCS, CT or MRI, hemotransfusions and so on) of the 17 patients and contrasted with the eclampsia without HELLP syndrome. Fisher exact test and χ2 test were used to test categorical variables. Results: There were 17 patients admitted concurrent eclampsia and HELLP syndrome, and 59 patients admitted eclampsia without HELLP syndrome. The incidence of concurrent eclampsia and HELLP syndrome was 21.8%. The maternal death rate was 35.3% (6/17) in concurrent eclampsia and HELLP syndrome patients, and significantly higher than the rate in eclampsia without HELLP syndrome group (P<0.05). There were more patients admitted to ICU and more patients need mechanical ventilation in concurrent eclampsia and HELLP syndrome (13/17 VS 20/59, 9/17 VS 14/59, P<188;0.05), also more patients with GCS≤8 in concurrent eclampsia and HELLP syndrome when admitted (P<0.05), compared to the eclampsia without HELLP syndrome. Nine patients had performed computed tomography scan (CT) or magnetic resonance imaging (MRI) and five (5/9) of them showed cerebral hemorrhage in concurrent eclampsia and HELLP syndrome group, while only 14 patients performed CT or MRI in eclampsia without HELLP syndrome and 3 of them showed cerebral hemorrhage. Conclusion: The incidence of concurrent eclampsia and HELLP syndrome was not rare, and also the maternal mortality rate was really high. It should be warning that the obstetrician should take great attention for these women, and consider life support treatment for them if necessarily.

The Role of Fibrinolytic and Antifibrinolytic Activities in the Pathophysiology of HELLP Syndrome

Objective. To determine the role of the fibrinolytic and antifibrinolytic systems in HELLP syndrome. Methods. This study consisted of patients with HELLP Syndrome (study group, n = 17), women who were admitted for routine prenatal care (pregnant control group, n = 21) and those presenting for routine gynecologic examination (non-pregnant control group, n = 21). Plasma tissue-type plasminogen activator (tPA), thrombin-activatable fibrinolysis inhibitor (TAFI), plasminogen activator inhibitor-1 (PAI-1), thrombin-antithrombin complex (TAT) and thrombomodulin (TM) were measured at admission for all groups. They were again measured after 7 days of biochemical improvement in HELLP Syndrome group. Results. The mean ages of women in the study, pregnant, and non-pregnant control groups were 29.82 ± 4.98, 29.71 ± 5.64, and 27.60 ± 4.21, respectively. Demographically, the patients in all three groups were similar with regard to maternal age, race, and body mass index. Compared to the control groups, the mean tPA, PAI-1, TAFI, TAT, and TM levels were significantly increased in HELLP Syndrome. The mean plasma TAFI antigen concentration 7 days after delivery was significantly lower compared to the baseline (5.84 ± 7.14 % change, p < 0.01). Significant decreases in the mean plasma concentrations were also found in tPA (21.78 ± 20.93 ng/mL mean difference, p < 0.01), PAI-1 (14.22 ± 10.38 ng/mL mean difference, p < 0.001), TAT (0.93 ± 1.19 ng/mL mean difference, p < 0.01), and TM (0.54 ± 0.94 ng/mL mean difference, p < 0.05). Conclusion. It is likely that the impaired fibrinolytic and antifibrinolytic systems, in response to thrombus formation, affect the pathophysiology of HELLP syndrome.

High frequency of methylenetetrahydrofolate reductase 677TT genotype in Hungarian HELLP syndrome patients determined by quantitative real-time PCR

Our aim was to determine the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism in hypertensive disorders during pregnancy. We conducted our experiments on isolated DNA samples of 73 healthy pregnant, 101 severe pre-eclamptic and 63 HELLP syndrome women in this study. The MTHFR C677T polymorphism was determined by quantitative real-time PCR method. A significantly higher number of the TT genotype (25.4%) was found in the HELLP syndrome group compared to the healthy (8.2%) and severe pre-eclamptics group (8.9%) (P=0.03). The frequency of the mutant T allele was found to be 45.2% of HELLP syndrome, whereas it was 32.2% of the healthy pregnant (P=0.03) and 30.2% (P=0.008) of the severe pre-eclamptic patients. In the HELLP group a high frequency of eclampsia was observed (12.6%) and among them 75% had the MTHFR C677T mutation.

Neonatal Outcome after Preterm Delivery in HELLP Syndrome

The present study compares neonatal outcome after preterm delivery of infants in pregnancies complicated by the HELLP syndrome or severe preeclampsia (PS). The maternal and neonatal charts of 71 out of a total of 409 pregnancies that were complicated by hypertensive disorders at Severance hospital between January 1995 and December 2004 were reviewed. Twenty-one pregnancies were complicated by HELLP syndrome and 50 pregnancies were complicated by PS. Fifty normotensive (NT) patients who delivered because of preterm labor comprised the control group. Results were analyzed by the chi-square test and ANOVA. Gestational age and maternal age at delivery were matched among the three groups. The neonatal outcomes of the HELLP syndrome group were compared with the PS and NT groups. There were significant differences between the HELLP syndrome group and the PS group in the incidence of intraventricular hemorrhage (IVH) (61.9% vs. 26%, p = 0.006), sepsis (85.7% vs. 44%, p = 0.003) and mechanical ventilation (MV) rate (81% vs. 54%, p = 0.039). There were significant differences between the HELLP syndrome group and the NT group in the incidence of neonatal death (ND) (19.5% vs. 2.0%, p = 0.034), respiratory distress syndrome (RDS) (38.1% vs. 8%, p = 0.0045), IVH (61.9% vs. 4%, p < 0.0001), sepsis (85.7% vs. 14%, p < 0.0001), intensive care (IC) (85.7% vs. 24%, p < 0.0001) and MV rate (80.1% vs. 14%, p < 0.0001). There were also significant differences between the PS and NT groups in the incidence of ND (20% vs. 2%, p = 0.0192), RDS (30% vs. 8%, p = 0.0085), IVH (26% vs. 4%, p = 0.0070), sepsis (44% vs. 14%, p = 0.0015), IC (78% vs. 24%, p < 0.0001), MV rate (54% vs. 14%, p < 0.0001) and low 5-min APGAR score (50% vs. 16%, p = 0.0005). This study shows increased morbidity in newborns of mothers complicated with HELLP syndrome and indicates that early, regular and high quality management of these patients is essential to improve both maternal and neonatal outcome.

Neonatal Outcome in Pregnancies after Preterm Delivery for HELLP Syndrome

Objective: To compare neonatal outcome after preterm delivery of infants where pregnancy had been complicated by the HELLP syndrome. Study Design: The maternal and neonatal charts of 475 consecutive pregnancies complicated by hypertensive disorders at our perinatal unit were reviewed. The HELLP syndrome was defined by previously published laboratory criteria. 93 women fulfilled the criteria and constituted our HELLP syndrome study group. 188 normotensive patients who were delivered because of preterm labor comprised the control group. Results were compared by means of χ² analysis and Student’s t test where appropriate. Results: There were 518 pregnancies complicated by hypertensive disorders and 93 by HELLP syndrome. The incidence of HELLP syndrome among women with severe preeclampsia was 19.5%. We found a significant difference in the incidence of intrauterine growth restriction (61.2 vs. 5.8%, p < 0.0001), intrauterine fetal death (13.9 vs. 6.9%, p = 0.035), abruptio placenta (13.9 vs. 2.6%, p = 0.001), and fetal distress (35.4 vs. 12.2%, p < 0.0001) between the two groups. There were no significant differences in complications (respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis and sepsis) between the HELLP syndrome group and controls. However, the neonatal death rate and the need for mechanical ventilation and neonatal intensive care were greater in the HELLP syndrome group. Conclusions: Our study suggests an increased mortality and morbidity in newborns of mothers complicated with HELLP syndrome that can be partly attributed to increased rates of intrauterine growth restriction and fetal distress, particularly beyond 32 weeks of gestation.

The Effect of Glyceryl Trinitrate on Hypertension in Women with Severe Preeclampsia, HELLP Syndrome, and Eclampsia

Objective: The goal of this study is to evaluate the effect of glyceryl trinitrate (GTN) in the management of hypertension in women with preeclampsia, eclampsia, and HELLP syndrome. Study Design: Fifty five women with preeclampsia, eclampsia, and HELLP syndrome administered GTN infusion for the management of hypertension were studied. Demographic, clinical, and perinatal outcome findings were collected for analyses. We recorded initial and maintenance doses of GTN, and duration of its use in prepartum and postpartum periods. We collected systolic and diastolic blood pressures (BPs) at admission and before the administration of GTN infusion. During the GTN infusion, we calculated average diastolic and systolic blood pressures 6 hours apart on the first day, 12 hours apart on the second day, and 24 hours apart on the third day. Results: Of 55 women, 24 with severe preeclampsia, 16 with HELLP syndrome, and 15 with eclampsia were included in this study. In severe preeclampsia group, GTN infusion significantly reduced systolic and diastolic BPs beginning from the second quarter and third quarter, respectively, of first day (p < 0.05). In the HELLP syndrome group, GTN infusion significantly decreased systolic and diastolic blood pressures beginning from the third quarter and second quarter, respectively, of the first day (p < 0.05). In the eclampsia group, GTN infusion significantly reduced systolic and diastolic blood pressures beginning from the third quarter and first quarter, respectively, of the first day (p < 0.05). Conclusion: In women with severe preeclampsia, eclampsia, and HELLP syndrome, infusion of GTN can be used as an alternative agent to well‐known drugs and causes no significant adverse effect to the mother and fetus.