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Are maternal and fetal parameters related to perinatal mortality in HELLP syndrome?
Arch Gynecol Obstet. 2011 Jun; 283(6):1227-32.AG

Abstract

PURPOSE

We designed this retrospective study to evaluate the association between maternal and fetal parameters and perinatal mortality in hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome.

METHODS

In this retrospective study, 152 pregnancies complicated with HELLP syndrome were evaluated. Risk factors recorded were maternal age, gravidity, gestational age (weeks), systolic and diastolic blood pressure, platelet count, alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), fetal weight, and Apgar scores. The association of these factors with perinatal mortality was determined. Statistical analyses were performed using the Chi-square (χ (2)) test with Yates' correction, the Student's t test, logarithmic transformation, and the logistic regression method.

RESULTS

Ninety-two (60.52%) patients had mild preeclampsia, 46 (22.2%) had eclampsia, and 14 (15.2%) had severe preeclampsia. The fetal mortality rate was higher in eclamptic and severe preeclamptic patients (P = 0.029). No correlation was found between maternal age, laboratory values (platelet count, ALT, AST, and LDH), or systolic and diastolic blood pressure and fetal morbidity. According to the logistic regression model, fetuses with prematurity, low birth weight, and low Apgar scores (Apgar score 1 ≤ 3 and Apgar score 5 ≤ 5) were found to be at significant risk for perinatal mortality (P < 0.001). The odds ratios (95% CI) were 3.0 (2-5), 3.42 (1.82-6.41), 0.62 (0.44-0.86) and 4.66 (2.04-10.63), respectively.

CONCLUSIONS

Maternal laboratory and clinical parameters were not associated with fetal mortality. Fetal prematurity, low birth weight, and low Apgar scores were significantly associated with fetal mortality. The HELLP syndrome and severe preeclampsia may be life threatening to the mother; therefore, the accepted treatment is expeditious delivery. Our study indicates that prevention of prematurity must be the main priority for the fetus in pregnancies complicated by the HELLP syndrome. This can be efficaciously achieved using glucocorticoid therapy for lung maturity and ensuring that delivery is at an experienced hospital with a multidisciplinary approach including a neonatal intensive care unit.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey. alijnk@hotmail.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20526778

Citation

Guzel, Ali Irfan, et al. "Are Maternal and Fetal Parameters Related to Perinatal Mortality in HELLP Syndrome?" Archives of Gynecology and Obstetrics, vol. 283, no. 6, 2011, pp. 1227-32.
Guzel AI, Kuyumcuoglu U, Celik Y. Are maternal and fetal parameters related to perinatal mortality in HELLP syndrome? Arch Gynecol Obstet. 2011;283(6):1227-32.
Guzel, A. I., Kuyumcuoglu, U., & Celik, Y. (2011). Are maternal and fetal parameters related to perinatal mortality in HELLP syndrome? Archives of Gynecology and Obstetrics, 283(6), 1227-32. https://doi.org/10.1007/s00404-010-1534-x
Guzel AI, Kuyumcuoglu U, Celik Y. Are Maternal and Fetal Parameters Related to Perinatal Mortality in HELLP Syndrome. Arch Gynecol Obstet. 2011;283(6):1227-32. PubMed PMID: 20526778.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are maternal and fetal parameters related to perinatal mortality in HELLP syndrome? AU - Guzel,Ali Irfan, AU - Kuyumcuoglu,Umur, AU - Celik,Yusuf, Y1 - 2010/06/06/ PY - 2010/01/25/received PY - 2010/05/25/accepted PY - 2010/6/8/entrez PY - 2010/6/8/pubmed PY - 2011/9/29/medline SP - 1227 EP - 32 JF - Archives of gynecology and obstetrics JO - Arch Gynecol Obstet VL - 283 IS - 6 N2 - PURPOSE: We designed this retrospective study to evaluate the association between maternal and fetal parameters and perinatal mortality in hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. METHODS: In this retrospective study, 152 pregnancies complicated with HELLP syndrome were evaluated. Risk factors recorded were maternal age, gravidity, gestational age (weeks), systolic and diastolic blood pressure, platelet count, alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), fetal weight, and Apgar scores. The association of these factors with perinatal mortality was determined. Statistical analyses were performed using the Chi-square (χ (2)) test with Yates' correction, the Student's t test, logarithmic transformation, and the logistic regression method. RESULTS: Ninety-two (60.52%) patients had mild preeclampsia, 46 (22.2%) had eclampsia, and 14 (15.2%) had severe preeclampsia. The fetal mortality rate was higher in eclamptic and severe preeclamptic patients (P = 0.029). No correlation was found between maternal age, laboratory values (platelet count, ALT, AST, and LDH), or systolic and diastolic blood pressure and fetal morbidity. According to the logistic regression model, fetuses with prematurity, low birth weight, and low Apgar scores (Apgar score 1 ≤ 3 and Apgar score 5 ≤ 5) were found to be at significant risk for perinatal mortality (P < 0.001). The odds ratios (95% CI) were 3.0 (2-5), 3.42 (1.82-6.41), 0.62 (0.44-0.86) and 4.66 (2.04-10.63), respectively. CONCLUSIONS: Maternal laboratory and clinical parameters were not associated with fetal mortality. Fetal prematurity, low birth weight, and low Apgar scores were significantly associated with fetal mortality. The HELLP syndrome and severe preeclampsia may be life threatening to the mother; therefore, the accepted treatment is expeditious delivery. Our study indicates that prevention of prematurity must be the main priority for the fetus in pregnancies complicated by the HELLP syndrome. This can be efficaciously achieved using glucocorticoid therapy for lung maturity and ensuring that delivery is at an experienced hospital with a multidisciplinary approach including a neonatal intensive care unit. SN - 1432-0711 UR - https://www.unboundmedicine.com/medline/citation/20526778/Are_maternal_and_fetal_parameters_related_to_perinatal_mortality_in_HELLP_syndrome DB - PRIME DP - Unbound Medicine ER -