Incidence Of HELLP Syndrome Research Articles

Intensive Care Management of Eclampsia with HELLP Syndrome: A Case Report

Background: The incidence of HELLP syndrome is approximately 0.1-1% of all pregnant women and 5.5% of patients admitted to the ICU. Hemolysis, elevated liver enzymes, and thrombocytopenia are the characteristics of HELLP syndrome.
 Case Presentation: A 38-year-old patient with diagnosed G4P3A0L3 31-32 weeks of preterm pregnancy + eclampsia on MgSO4 regimen, HELLP syndrome + twice previous Sectio cesarean + breech presentation. On physical examination, the general condition was blood pressure 199/103 mmHg. The results of laboratory tests post-op were hemoglobin 7,1 g/dL, leukocytes 15.930, hematocrit 24%, and platelets 38,000. The results of other laboratory tests showed decreased albumin levels (Alb 2,4), increased levels of total bilirubin 14,7, direct bilirubin 10,8 and indirect bilirubin 3,9, increased liver enzyme SGOT 2001 SGPT 513.
 Conclusion: HELLP syndrome is a threatening clinical problem. Appropriate and adequate management, especially in the Intensive care unit, is needed to prevent severe complications to reduce morbidity and mortality rates in patients with HELLP syndrome.

The Incidence of HELLP Syndrome as a Complication of Preeclampsia and As a Determining Factor of Premature Birth

ntroduction: HELLP syndrome is a variant of preeclampsia that evolves with hemolysis, elevated transaminases and bilirubin as well as thrombocytopenia, being able to generate severe complications during gestation.

FETO-MATERNAL OUTCOME IN HELLP SYNDROME

Background: HELLP Syndrome is a serious obstetric complication in pregnancy characterised by haemolysis, elevated liver enzymes and low platelet count. Incidence is 0.5-0.9% of all pregnancies and in 10-20% of cases with severe preeclampsia (PE) and eclampsia. Aim of the present study is to evaluate the incidence, demographic and clinical prole; and maternal and perinatal outcome in women with HELLP syndrome. Methods: All women with hypertension with 28 weeks of gestation admitted to labour room in a single unit of tertiary care hospital at Government medical College Kota, Rajasthan from January 2019 to June 2020 and fullled the inclusion criteria. Incidence of HELLP syndrome was 1.9% of total deliveries and Results: 15.3% of total HDP cases. Out of 50 cases of HELLP syndrome, 62% belonged to class III, 22% to class II and 16% to class I of Mississippi classication. Mean age of patients of HELLP syndrome in present study was 24.72 4.18 years. 32 (64%) were primigravida while 18 (36%) were gravida two or more. Mean gestational age in study group was 35.98+ -3.33 week. Maternal mortality was seen in 6 (12%) cases and most common cause attributed to MODS 4 (66.67%). Conclusions: HELLP Syndrome is a severe variant and a dreadful complication of PE and eclampsia, it needs early diagnosis which is based upon clinical and laboratory ndings and timely intervention in the form of termination of pregnancy to arrest further progress of pathophysiology leading to complications.

Maternal risk factors and adverse birth outcomes associated with HELLP syndrome: a population‐based study

We assessed the incidence, risk factors and adverse birth outcomes associated with elevated liver enzymes and low platelets (HELLP) syndrome. A retrospective population-based cohort study. Canada (excluding Quebec), 2012/2013-2015/2016. Mothers with a singleton hospital live birth or stillbirth at ≥24weeks' gestation (n=1078323). HELLP syndrome was identified using ICD-10-CA diagnostic code from delivery hospitalisation data. We used logistic regression to identify independent risk factors for HELLP syndrome by obtaining adjusted odds ratios (AOR) and 95% confidence intervals (CI), and to assess the associations with adverse outcomes. Adverse maternal (e.g. eclampsia) and fetal/neonatal outcomes (e.g. intraventricular haemorrhage, perinatal death). The incidence of HELLP syndrome was 2.5 per 1000 singleton deliveries (n=2663). Risk factors included: age ≥35years, rural residence, nulliparity, parity ≥4, pre-pregnancy and gestational hypertension and diabetes, assisted reproduction, chronic cardiac conditions, systemic lupus erythematosus, obesity, chronic hepatic conditions, placental disorders (e.g. fetomaternal transfusion) and congenital anomalies. PROM and age <25years were inversely associated with HELLP syndrome (P-values <0.05). Women with the syndrome had a 10-fold higher maternal mortality (95% CI 1.6-84.3) and elevated severe maternal morbidity (9.6 versus 121.7 per 1000; AOR12.5, 95% CI 11.1-14.1); and higher perinatal mortality (4.3 versus 21.0 per 1000; AOR4.5, 95% CI 3.5-5.9) and perinatal mortality/severe neonatal morbidity (21.2 versus 202.4 per 1000; AOR10.7, 95% CI 9.7-11.8). HELLP syndrome is associated with specific pre-pregnancy and pregnancy risk factors, higher rates of maternal death, and substantially higher severe maternal morbidity, perinatal mortality and severe neonatal morbidity. HELLP syndrome is associated with higher maternal death rate, and substantially higher severe maternal and neonatal morbidity, and perinatal mortality.

HELLP Syndrome with surgical complication

HELLP Syndrome with surgical complication - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/j.ijogr.2019.122, Indian Journal of Obstetrics and Gynecology Research-Indian J Obstet Gynecol Res

A Study of HELLP Syndrome among Cases of Pre-Eclampsia and Eclampsia: Incidence and Correlation of Laboratory Parameters

Objective: To determine the incidence of HELLP syndrome amongst cases of Eclampsia and severe pre eclampsia admitted to our hospital and to study the correlation of laboratory parameters with the mean arterial pressure (MAP) and with each other. Method: 23...

Do clinical and laboratory parameters effect maternal and fetal outcomes in pregnancies complicated with hemolysis, elevated liver enzymes, and low platelet count syndrome?

The aim of the study was to investigate whether the clinical features and laboratory parameters affect maternal and fetal outcomes in pregnancies complicated with HELLP syndrome. The medical records of pregnant patients complicated with HELLP syndrome were analyzed retrospectively between June 01, 2003 and June 01, 2010. The demographic data, medical history, admission symptoms, clinical and laboratory findings and recovery time were evaluated. The adverse maternal outcomes including eclampsia, placental abruption, disseminated intravascular coagulation, postpartum hemorrhage, pulmonary complications, cerebral edema and visual loss were recorded. Fetal growth restriction, necessity for neonatal intensive care unit admission and perinatal mortality were recorded as an adverse fetal outcome. The incidence of HELLP syndrome was 0.52%. The mean age of the patients was 28.93±7.90 (range 17-45). HELLP syndrome was diagnosed on average in the 33.68±4.41(th) (ranged 24-40) week of gestation. Eighteen cases (40.9%) were nullipara and twenty-six cases (59.1%) multipara. The most common complications were eclampsia (40.9%) and abruption placenta (15.9%). Pregnancy was terminated within 48 hours in all patients. The rate of cesarean section was 90.9%. Perinatal mortality rate in HELLP syndrome was 31.8%. There was no maternal mortality. Neither clinical characteristics nor laboratory parameters was found effective for prediction of adverse maternal and fetal outcomes.

A clinical study of 32 cases with HELLP syndrome

Objective To analyze the clinical presentation and maternal-neonatal outcome of HELLP syndrome.Methods 32 cases with HELLP syndrome from January 2003 to January 2009 were analyzed retrospectively.Results The incidence of HELLP syndrome in preeclampsia was 3.7%.Complete HELLP were 17 cases,partial HELLP were 15 cases.Two pregnant women died(one case of intracranial hemorrhage,one case of acute left cardiac failure),the mortality was 6.3%.Five newborns died,the mortality was 15.6%.The main materal complications were DIC(8 cases),placental abruption(2 cases),intracranial hemorrhage(2 cases).The main perinatal complications were preterm labor(20 cases),newborn asphysia(17 cases),SGA(15 cases).Conclusion HELLP syndrome is one of the most serious obstetric complications,early diagnosis,early therapy,controlling hypertension and termination of pregnancy in time are most important for treatment. Key words: Hypertension,pregnancy; HELLP Syndrome

Maternal and fetal outcome of pregnancy complicated by HELLP syndrome

Objective. The study evaluated the maternal and fetal outcome in 64 pregnancies complicated by HELLP syndrome.Methods. A retrospective analysis of the medical records was performed of patients with HELLP syndrome managed at this tertiary Obstetric unit between January 1996 and December 2005, who were admitted for preeclamsia/eclampsia and had documented evidence of hemolysis, elevated liver enzymes and low platelet count. Maternal and neonatal complications were recorded and analyzed.Results. The incidence of HELLP syndrome in the study was 8.3%. Mean gestational age at delivery was 32.4 ± 4.2 weeks and mean birth weight was 1851 ± 810 g. Forty-two percent of the patients had deliveries <32 weeks and 28% IUGR. Respiratory distress syndrome was the main indication for NICU admissions (33.9%). The PNM rate was 20%. Maternal morbidity rate was 34%. The most common maternal complications were abruptio placentae (36.4%) and DIC (31.8%). There was no maternal death.Conclusion. Once the diagnosis of HELLP syndrome is confirmed, the management depends on several obstetric and maternal variables like gestational age, severity of laboratory abnormalities and fetal status. As soon as the maternal condition is stabilized and fetal assessment is obtained, prompt delivery of the fetus is indicated. It is not yet established whether expectant management in preterm pregnancies with HELLP syndrome would improve perinatal outcome.

Hemolysis Elevated Liver Low Platelet Acute Renal Dysfunction syndrome: evidence for a new entity in the critically ill obstetric patient

The incidence of HELLP syndrome complicated with acute renal failure (ARF) is unknown because of a paucity of large series dealing with this subject. Recent experimental and clinical investigations indicate that ARF presents a condition that exerts a fundamental impact on the course of disease, the evolution of associated complications and on prognosis independently from the type and severity of the underlying disease.

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 Impact of Parity on the Incidence of HELLP Syndrome and Small for Gestational Age Infants in Hypertensive Pregnant Women

Objectives: To determine whether maternal and fetal complications such as HELLP hemolysis, elevated liver enzymes, low platelets) syndrome and the incidence of small for gestational age infants in women with preeclampsia and gestational hypertension differ with both gravidity and parity.Study Design: The charts of 441 hypertensive women, 182 with preeclampsia and 259 with gestational hypertension, presenting for delivery at B.C. Women’s Hospital were retrospectively reviewed. Multiple clinical parameters, including gestational age at presentation the incidence of small for gestational age SGA infants, HELLP syndrome, and the severity of preeclampsia, were compared among three groups of women: (A) primigravid primiparous, (B) multigravid primiparous, and (C) multiparous. Mean values between the groups were compared using analysis of variance with pair-wise comparison using the Tukey test.Results: The incidence of HELLP syndrome among the women with preeclampsia was similar in groups A and B 35% and 50%, respectively), but significantly lower (p < 0.012) in group C (19%). The incidence of small for gestational age infants among the women with preeclampsia was similar for groups A, B, and C (27%, 31% and 19%) respectively). In the gestational hypertensive group the incidence of SGA infants was similar for groups A, B, and C (14%, 11%, and 12% respectively).Conclusions: The preeclamptic primigravid primiparous and multigravid primiparous groups behaved similarly in their clinical expression of hypertensive complications but differed from the multiparous group by having a higher incidence of HELLP syndrome. The incidence of complications in hypertensive pregnant women varied by parity but not by gravidity. The gestational hypertensive groups did not differ in their clinical expression of hypertensive complications.

Clinical and biophysical aspects of HELLP-syndrome.

The maternal-perinatal outcome and the significance of biophysical parameters in HELPP syndrome patients were evaluated. Sixty cases of HELLP syndrome were determined by retrospective analysis. Medical history, correlation of clinical, laboratory findings, records of fetomaternal Doppler studies, Nonstress test and maternal-perinatal outcome data were evaluated. Chi-square test was used for statistical analysis, and p < 0.05 was accepted as the significance level. The incidence of HELLP syndrome in our institution was 1.03%. Mean gestational age at birth was 33.2 weeks, mean birth weight was 1861 +/- 710 g and mean umbilical pH was 7.25 +/- 0.13. Neonatal thrombocytopenia was demonstrable in 38% of neonates. Patients with low antepartal platelets (< 60,000/microliter) had a significantly higher incidence of intrauterine growth retarded fetuses than patients with higher platelet counts (p = 0.002). Doppler flow measurements were performed in 33 patients (55%). In 16 (48.4%) a pathological Doppler flow was documented. Doppler findings demonstrated very high sensitivity (83%) and specificity (80%) in predicting adverse outcome in growth retarded fetuses. In 17 patients (27%) fetal heart rate monitoring had an obvious pathologic pattern. Respiratory distress syndrome (74.4%) was the main indication for NICU admission. Perinatal mortality rate was 8.3% and neonatal mortality rate was 11.6%. Maternal morbidity rate was 30%. The most commonly observed maternal complications were abruptio placentae (n = 8), disseminated intravascular coagulation (n = 3) and severe postpartal bleeding (n = 3). In HELLP syndrome patients it is very important to closely follow maternal vital signs and fluid intake and output, and to perform fetal status assessment tests. Of the biophysical parameters, Doppler flow measurement is an especially helpful predictor of poor perinatal outcome in growth retarded fetuses in HELLP patients. Patients with very low platelets have a significantly higher risk of intrauterine growth retarded fetuses.

Morbidité et mortalité materno-fœtales associées au Hellp syndrome

Objectives: Our purpose was to describe the effects of serious obstetric complications on maternal and perinatal outcome in pregnancies complicated by Hellp syndrome. Study design: Retrospective study. Patients: Sixteen patients managed from January 1994 through December 1998 in whom pregnancy was complicated by Hellp Syndrome. Results: The incidence of Hellp syndrome among women with severe preeclampsia and/or eclampsia (164 cases) was 9.7%. Fourteen cases occurred before and two after delivery. In nine cases, Hellp occurred before 32 weeks of gestation and later in two other cases. Mean gestationnal age at delivery was 32.4 weeks. Serious maternal morbidity included acute renal failure (five cases), disseminated intravascular coagulation (two cases), pulmonary oedema (one case), severe ascites (five cases), pleural effusion (three cases), adult respiratory distress syndrome (one case). Abruptio placenta, acute renal failure and disseminated intravascular coagulation were always associated. Ten patients required transfusions with blood products. Caesarean delivery was performed in 15 cases. General anaesthesia was used in all patients. There was one maternal death from multiple organ failure. Perinatal outcome was poor. Six perinatal deaths were related to abruptio placenta, intrauterine asphyxia and extreme prematurity. Conclusion: The high maternal and perinatal mortality and morbidity reported with the presence of Hellp syndrome requires maternal-fetal follow-up in a tertiary centre where intensive maternal and neonatal care are available.

Ethnocultural variation in the incidence of HELLP syndrome in a hypertensive pregnant population: [formula omitted], S. Wilson x. Dept. Ob/Gyn, UBC, Van. BC. Canada, V6H 3V5

Ethnocultural variation in the incidence of HELLP syndrome in a hypertensive pregnant population: [formula omitted], S. Wilson x. Dept. Ob/Gyn, UBC, Van. BC. Canada, V6H 3V5

Hellp syndrome: Incidence and maternal-fetal outcome—a prospective study

To determine the incidence of Hellp syndrome (HS) and the maternal fetal outcome associated with its occurrence. A prospective study during a 6-month period. The department of obstetrics and gynecology and the Intensive Care Unit of a 700 bed teaching hospital. Sixty-two consecutive preeclamptic and eclamptic women. All patients were systematically investigated for the biological markers of HS. The effects of the occurrence of HS on maternal and fetal prognosis were evaluated by comparing for prognosis indicators usually assessed in gravidic hypertension, pre-eclamptic and eclamptic woman who exhibited HS (HS+ subgroup) with HS free patients (HS- subgroup). HS was found in 12 out of the 62 pre-eclamptic and eclamptic women (19.3%). Its occurrence was associated with higher maternal mortality (16.7% vs 0%; p = 0.03), a greater incidence of eclamptic crisis (50% vs 20%; p = 0.03), severe hypertension (33% vs 8%; p = 0.03) and episodes of acute renal failure (66% vs 30%; p = 0.02). Mean proteinuria was also higher in HS+ patients (4.6 +/- 3.3 vs 2.2 +/- 2.5 g/day; p = 0.001). However, fetal outcome was not significantly altered. Pre-eclampsia and eclampsia may be more severe in the presence of HS with a worsening of maternal prognosis while fetal outcome seems not altered.

FREQUENCY OF HELLP SYNDROME IN PRE- ECLAMPSIA AND ECLAMPSIA PATIENTS OF THE CATCHMENT AREA OF SAIDU TEACHING HOSPITAL SWAT

Objectives: The objective of the study was to determine the frequency of HELLPsyndrome in preeclampsiaand eclampsia patients presented to saidu teaching hospital Swat.&#x0D; Methodology: This was a descriptive, cross sectional study. It was conducted in the department ofgynaecology and obstetrics of Saidu Teaching Hospital Swat. All pregnant women attending antenatal clinicduring T1 Jan 2007 to 31s' Dec 2009 were included in the study. Women after 20 weeks of gestation withpreeclampsia requiring admission in obstetric ward for monitoring and controlling blood pressure and allwho were admitted in labour room with severe preeclampsia and eclampsia were included while womenwith gestational hypertension but no proteinurea were excluded. Non probability purposive samplingtechnique was used in the study.&#x0D; Result: During three years time period, 16722 pregnant women were registered, out of which 537 werediagnosed having preeclampsia, 3.21% (n = 16722) . While 39 patients among 537, were diagnosed withHELLPsyndrome, 7.26% (n = 537) in limited and 0.227% (n = 16722) in the overall sample population. Outof total 39 patients 38 were antenatal 1 was post-natal. About 69.25% women were between 30 to 40 weeksof gestation and 30.7% were less than 30 weeks of gestation. In our study the frequency of HELLPsyndromewas high between 26-30 years (38.46%) and in multigravidas (46.15%).&#x0D; Conclusion: The study revealed that although in spite of backward area, lack of education and health careawareness with special reference to mother and child health the incidence of HELLP syndrome is less thanthe internationally reported data, but this may be due the fact that all patients with eclampsia and preeclampsia do not reached hospital and treated at home due to superstitious believes. A community basedintervention is needed to improve health awareness and education. All patients with preeclampsia andeclampsia needs to be investigated for HELLP syndrome and those with HELLP syndrome should beprovide the best possible care at the appropriate time.&#x0D; Key words: Pre-Eclampsia, Eclampsia, HELLPsyndrome