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Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome)
Am J Obstet Gynecol. 1993 Oct; 169(4):1000-6.AJ

Abstract

OBJECTIVE

Our purpose was to describe the incidence and effects of serious obstetric complications on maternal outcome in pregnancies complicated by HELLP syndrome.

STUDY DESIGN

A prospective cohort study was performed on 442 pregnancies with HELLP syndrome managed at this center from August 1977 through July 1992.

RESULTS

Of 437 women who had 442 pregnancies with HELLP syndrome; 309 (70%) of the cases occurred ante partum and 133 (30%) post partum; 149 (11%) developed at < 27 weeks and 80 (18%) at term. Maternal mortality was 1.1% (five patients). Serious maternal morbidity included disseminated intravascular coagulation (21%), abruptio placentae (16%), acute renal failure (7.7%), pulmonary edema (6%), subcapsular liver hematoma (0.9%), and retinal detachment (0.9%). Fifty-five percent of patients required transfusions with blood or blood products, and 2% required laparotomies for major intraabdominal bleeding. Abruptio placentae was strongly correlated with the development of disseminated intravascular coagulation (p < 0.0001), acute renal failure (p < 0.001), and pulmonary edema (p < 0.01). Moreover, there was a strong association between pulmonary edema and acute renal failure (p < 0.0001). There were no differences in laboratory findings between HELLP syndrome before and after delivery; however, women with postpartum HELLP syndrome had significantly higher incidences of pulmonary edema and renal failure.

CONCLUSION

HELLP syndrome is associated with serious maternal morbidity, especially when it arises in the postpartum period.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, University of Tennessee, Memphis.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

8238109

Citation

Sibai, B M., et al. "Maternal Morbidity and Mortality in 442 Pregnancies With Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP Syndrome)." American Journal of Obstetrics and Gynecology, vol. 169, no. 4, 1993, pp. 1000-6.
Sibai BM, Ramadan MK, Usta I, et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol. 1993;169(4):1000-6.
Sibai, B. M., Ramadan, M. K., Usta, I., Salama, M., Mercer, B. M., & Friedman, S. A. (1993). Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). American Journal of Obstetrics and Gynecology, 169(4), 1000-6.
Sibai BM, et al. Maternal Morbidity and Mortality in 442 Pregnancies With Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP Syndrome). Am J Obstet Gynecol. 1993;169(4):1000-6. PubMed PMID: 8238109.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) AU - Sibai,B M, AU - Ramadan,M K, AU - Usta,I, AU - Salama,M, AU - Mercer,B M, AU - Friedman,S A, PY - 1993/10/1/pubmed PY - 1993/10/1/medline PY - 1993/10/1/entrez SP - 1000 EP - 6 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 169 IS - 4 N2 - OBJECTIVE: Our purpose was to describe the incidence and effects of serious obstetric complications on maternal outcome in pregnancies complicated by HELLP syndrome. STUDY DESIGN: A prospective cohort study was performed on 442 pregnancies with HELLP syndrome managed at this center from August 1977 through July 1992. RESULTS: Of 437 women who had 442 pregnancies with HELLP syndrome; 309 (70%) of the cases occurred ante partum and 133 (30%) post partum; 149 (11%) developed at < 27 weeks and 80 (18%) at term. Maternal mortality was 1.1% (five patients). Serious maternal morbidity included disseminated intravascular coagulation (21%), abruptio placentae (16%), acute renal failure (7.7%), pulmonary edema (6%), subcapsular liver hematoma (0.9%), and retinal detachment (0.9%). Fifty-five percent of patients required transfusions with blood or blood products, and 2% required laparotomies for major intraabdominal bleeding. Abruptio placentae was strongly correlated with the development of disseminated intravascular coagulation (p < 0.0001), acute renal failure (p < 0.001), and pulmonary edema (p < 0.01). Moreover, there was a strong association between pulmonary edema and acute renal failure (p < 0.0001). There were no differences in laboratory findings between HELLP syndrome before and after delivery; however, women with postpartum HELLP syndrome had significantly higher incidences of pulmonary edema and renal failure. CONCLUSION: HELLP syndrome is associated with serious maternal morbidity, especially when it arises in the postpartum period. SN - 0002-9378 UR - https://www.unboundmedicine.com/medline/citation/8238109/Maternal_morbidity_and_mortality_in_442_pregnancies_with_hemolysis_elevated_liver_enzymes_and_low_platelets__HELLP_syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/0002-9378(93)90043-I DB - PRIME DP - Unbound Medicine ER -