HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome versus
severe preeclampsia: Onset at <=28.0 weeks' gestation.
General Obstetrics and Gynecology American Journal of Obstetrics & Gynecology. 183(6):1475-1479, December 2000. Haddad, Bassam MD a; Barton, John R. MD b; Livingston, Jeffrey C. MD a; Chahine, Rabih MD a; Sibai, Baha M. MD c Abstract: Objective: Our purpose was to determine whether the onset of the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome in women at <=28.0 weeks' gestation is associated with an increased risk of adverse maternal and perinatal outcomes in comparison with the risk for women with severe preeclampsia but without the HELLP syndrome at a similar gestational age. Study Design: Sixty-four patients with either the HELLP syndrome (n = 32) or severe preeclampsia but absent HELLP syndrome laboratory test results (n = 32), admitted at <=28.0 weeks' gestation between July 1, 1992, and April 30, 1999, were studied. Maternal and perinatal outcomes were compared between the 2 groups. Statistical analysis was performed by the Student t test and the Fisher exact test. Results: There were no significant differences between the 2 groups regarding AfricanAmerican race (59% vs 75%), nulliparity (50% vs 56%), or the use of corticosteroids (59% vs 78%). There were no maternal deaths. One woman with the HELLP syndrome had a liver hematoma. The rate at which transfusion of blood products was required was significantly greater in women with the HELLP syndrome than in those with severe preeclampsia only (25% vs 3%;P < .05). There were no significant differences between the 2 groups with respect to eclampsia (16% vs 13%), abruptio placentae (6% vs 9%), disseminated intravascular coagulopathy (13% vs 0%), pulmonary edema (13% vs 6%), acute renal failure (3% vs 0%), pleural effusion (3% vs 3%), or ascites (6% vs 16%). No significant differences were found between the 2 groups with respect to neonatal death (11% vs 17%), respiratory distress syndrome (78% vs 86%), or composite neonatal morbidity. Conclusions: Except for the need for transfusion of blood products in women with the HELLP syndrome, onset at <=28.0 weeks' gestation is not associated with an increased risk of adverse maternal or neonatal outcomes in comparison with the risk for women with severe preeclampsia but without the HELLP syndrome at a similar gestational age. (Am J Obstet Gynecol 2000;183:1475-9.) (C) Mosby-Year Book Inc. 2000. All Rights Reserved. http://pt.wkhealth.com/pt/re/ajog/abstract.00000447-20001200000021.htm;jsessionid=GyFbqLCVLRyXJcn0kmRL53LNNCy2pxvQTNjHd5GDTvNLh KSWp25z!-1804036389!-949856145!8091!-1
Obstetrics & Gynecology 1989;73:97-102
1989 by The American College of Obstetricians and Gynecologists Disseminated intravascular coagulation and the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia PA Van Dam, M Renier, M Baekelandt, P Buytaert, and F Uyttenbroeck To clarify the role of disseminated intravascular coagulation (DIC) in women with the hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, serial coagulation studies were performed prospectively in 18 patients. A semiquantitative DIC scoring system was used retrospectively to augment the diagnostic confidence of coagulopathy. At the time of admission to the hospital, three patients showed no evidence of DIC, eight had suspected DIC, and seven had manifest DIC. The intravascular coagulation process was progressive in all patients; upon delivery, eight patients proved to have suspected DIC and ten had manifest DIC. The laboratory criteria of DIC were found to agree with the degree of organ dysfunction. Patients with manifest DIC at delivery developed significantly more life-threatening maternal complications than did patients with suspected DIC (P less than .02). Conservative management was not possible in any patients who were admitted with overt DIC because of deterioration of maternal and fetal status. Application of a sensitive DIC scoring system may be valuable in managing patients with the HELLP syndrome and selecting patients who may be treated expectantly. http://www.greenjournal.org/cgi/content/abstract/73/1/97 Clinical analysis of six cases with hemolysis,elevated liver enzymes and low platelet count syndrome WANG Yu-ping, FENG Cui-ping, CHEN Qing-yun Department of Obstetrics and Gynecology,China-Japan Friendship Hospital,Beijing 100029, ChinaAbstract:ObjectiveTo analyze the clinical character,diagnosis,treatment and prognosis of patients with hemolysis,elevated liver enzymes and low platelet count HELLP syndrome.MethodsThe clinical data of six cases with HELLP syndrome were analyzed retrospectively during the past twelve years.ResultsThere were four cases with complete HELLP syndrome and two cases with partial HELLP syndrome.4 cases had special characters such as abdominal pain or discomfort in top right part;teacolor urine etc.Two cases had no sign of hypertension complicating pregnancy.The major complications were disseminated intravascular coagulation, cerebral hemorrhage companied with hydrocephalus,acute renal failure and placental abruption.Three maternal deaths were attributed to severe complications.Two perinatal deaths were related to abrnption placenta and intrauterine asphyxia.ConclusionHELLP syndrome is a severe life threatening disease,which has high maternal and perinatal mortality.So it should be identified by its special characters and diagnosed as fast as possible.The severe patient should be treated with termination of pregnancy as soon as possible and prevention of severe complications.[] Key words:pregnancy complications,cardiovascular;HELLP syndrome
2006 20 5 JOURNAL OF CHINA-JAPAN FRIENDSHIP HOSPITAL 274-277 E
Low-Molecular-Weight Heparin Added To Aspirin in The Prevention of Recurrent Early-Onset Pre-Eclampsia in Women With Inheritable Thrombophilia: The FRUIT-RCT