Risk Factors for Perinatal Loss in Women with HELLP Syndrome
Objective of the Study: To identify risk factors for perinatal morbidity and mortality in women with severe pre-eclampsia complicated by HELLP syndrome.
Study Design: This was a retrospective, comparative study.
Materials and Methods: The study included evaluation of perinatal outcomes in 268 pregnant women who gave birth at second- and third-level maternity homes in the Republic of Tajikistan. The main group consisted of 36 women whose pregnancies were complicated by severe pre-eclampsia and HELLP syndrome, and their newborns. In the comparison group were 232 women with severe pre-eclampsia who did not have HELLP syndrome, and their newborns.
Study Results: Of the 36 newborns in the main group, six babies (16.7%) born at 29-33 weeks died in the early neonatal period: two (5.6%) had grade 3 fetal growth restriction and four (11.1%) died of infant respiratory distress syndrome accompanied by intrauterine pneumonia. Of the 232 babies in the comparison group, two (0.9%) were stillborn and five (2.2%) died in the early neonatal period.
In the main group 83.3% of the women had irregularly contracted and dysmorphic RBC, fragmented RBC (schistocytes), and red cell polychromasia. Similar changes were observed in the six women with HELLP syndrome whose babies died in the early neonatal period, while in the comparison group women with poor perinatal outcomes did not have such changes. All women in the main group had thrombocytopenia with platelet levels between 70×109/L and 112×109/L. A significant reduction of platelet levels led to bleeding in three women; and five out of the 36 newborns were diagnosed with intraventricular hemorrhage. Blood levels of ALT in the patients with HELLP syndrome ranged from 57 to 170 U/L. Mothers whose infants died within the first seven days of life had the highest ALT blood levels—120-170 U/L.
Analysis of perinatal mortality showed that all of the women with HELLP syndrome had markedly elevated bilirubin levels and abnormal proteinuria (3.3-13.2 g/L).
Conclusion: Severe pre-eclampsia complicated by HELLP syndrome is a high-risk factor for poor perinatal outcomes. In women with HELLP syndrome, the risk factors for poor perinatal outcomes include prematurity, severe thrombocytopenia, proteinuria, hyperbilirubinemia, and schistocytes in the peripheral blood.
The authors declare that they do not have any conflict of interests.
V.Yu. Tsoy — Avicenna Tajik State Medical University; 139 Rudaki St., Dushanbe, Republic of Tajikistan 734003. E-mail: VTFrangasNonFlectas@gmail.com
F.Z. Olimova — Avicenna Tajik State Medical University; 139 Rudaki St., Dushanbe, Republic of Tajikistan 734003. E-mail: email@example.com
U.D. Uzakova — Avicenna Tajik State Medical University; 139 Rudaki St., Dushanbe, Republic of Tajikistan 734003. E-mail: firstname.lastname@example.org
M.F. Dodkhoyeva — Avicenna Tajik State Medical University; 139 Rudaki St., Dushanbe, Republic of Tajikistan 734003. E-mail: email@example.com
R.A. Abdullayeva — Avicenna Tajik State Medical University; 139 Rudaki St., Dushanbe, Republic of Tajikistan 734003. E-mail: firstname.lastname@example.org
S.M. Mukhamadieva — Institute of Postgraduate Healthcare Education; 78 Ismail Samani Prospect, Dushanbe, Republic of Tajikistan 734026. E-mail: email@example.com
- Отчет министерства здравоохранения и социальной защиты населения Республики Таджикистан, 2018 г. Коллегия министерства здравоохранения и социальной защиты населения Республики Таджикистан, август 2018 г. [Otchet ministerstva zdravookhraneniya i sotsial'noi zashchity naseleniya Respubliki Tadzhikistan, 2018 g. Kollegiya ministerstva zdravookhraneniya i sotsial'noi zashchity naseleniya Respubliki Tadzhikistan, avgust 2018 g. (in Russian)]
- Aloizos S., Seretis C., Liakos N., Aravosita P., Mystakelli C., Kanna E. et al. HELLP syndrome: understanding and management of a pregnancy-specific disease. J. Obstet. Gynecol. 2013; 33(4): 331–7. DOI: 10.3109/01443615.2013.775231
- Hupucнi P., Sziller I., Hruby E., Rigó B., Szabó G., Papp Z. The rate of maternal complications in 107 pregnancies complicated with HELLP syndrome. Orv. Hetil. 2006; 147(29): 1377–85.
- Kongwattanakul K., Saksiriwuttho P., Chaiyarach S., Thepsutham-marat K. Incidence, characteristics, maternal complications, and perinatal outcomes associated with preeclampsia with severe features and HELLP syndrome. Int. J. Womens Health. 2018; 10: 371–7. DOI: 10.2147/IJWH.S168569
- Malmström O., Morken N.H. HELLP syndrome, risk factors in first and second pregnancy: a population-based cohort study. Acta Obstet. Gynecol. Scand. 2018; 97(6): 709–16. DOI: 10.1111/aogs.13322
- Haram K., Svendsen E., Abildgaard U. The HELLP syndrome: clinical issues and management. A review. BMC Pregnancy and Childbirth. 2009; 9: 8. DOI: 10.1186/1471-2393-9-8
- Rao D., Kumar Chaudhari N., Moore R.M., Jim B. HELLP syndrome: a diagnostic conundrum with severe complications. BMJ Case Rep. 2016; 2016: bcr2016216802. DOI: 10.1136/bcr-2016-216802
- Barton J.R., Sibai B.M. Hepatic imaging in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). Am. J. Obstet. Gynecol. 1996; 174(6): 1820–7.
- Weinstein L. It has been a great ride: the history of HELLP syndrome. Am. J. Obstet. Gynecol.2005; 193(3 Pt1): 860–3. DOI: 10.1016/j.ajog.2005.06.058
- Rabinovich A., Holtzman K., Shoham-Vardi I., Mazor M., Erez O. Oligohyd-ramnios is an independent risk factor for perinatal morbidity among women with preeclampsia who delivered preterm. J. Matern. Fetal Neonatal Med. 2017: 1–7. DOI: 10.1080/14767058.2017.1417377
- Ditisheim A., Sibai B.M. Diagnosis and management of HELLP syndrome complicated by liver hematoma. Clin. Obstet. Gynecol. 2017; 60(1): 190–7. DOI: 10.1097/GRF.0000000000000253
- Chu Lam M.T., Dierking E. Intensive Care Unit issues in eclampsia and HELLP syndrome. Int. J. Crit. Illn. Inj. Sci. 2017; 7(3): 136–41. DOI: 10.4103/IJCIIS.IJCIIS_33_17
- Katz L., de Amorim M.M., Figueiroa J.N., Pinto e Silva J.L. Postpartum dexamethasone for hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome: a double-blind, placebo-controlled, randomized clinical trial. Am. J. Obstet. Gynecol. 2008; 198(3): 283.e.1–8. DOI: 10.1016/j.ajog.2007.10.797
- Sibai B.M. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet. Gynecol. 2004; 103(5 Pt1): 981–91. DOI: 10.1097/01.AOG.0000126245.35811.2a
- Повзун С.А., Горбакова Л.Ш. Наблюдение HELLP-синдрома со смертельным исходом. Архив патологии. 2015; 77(5): 52–7. [Povzun S.A., Gorbakova L.Sh. Nablyudenie HELLP-sindroma so smertel'nym iskhodom. Arkhiv patologii. 2015; 77(5): 52–7. (in Russian)]