Perinatal outcomes in HELLP syndrome
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Objective: The HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome is a severe complication of pre-eclampsia with high risk for mother and fetus. This study was conducted to evaluate the incidence of serious maternal and fetal morbidities and adverse outcomes in women with HELLP syndrome. Materials and Methods: Totally 64 pregnancies complicated by HELLP syndrome managed between January 1, 2000 and August 31, 2006 were reviewed. The demographic data, presenting signs and symptoms, and laboratory findings were evaluated. We recorded the adverse maternal outcomes including eclampsia, abruptio placenta, disseminated intravascular coagulopathy (DIC), acute renal failure (ARF), pulmonary complications, the need of mechanical ventilation, severe ascites, the need for transfusion, intracranial infarct or hemorrhage, and maternal death. Perinatal complications including IUGR, oligohydramniosis, fetal distress, Apgar score in first and fifth mins <7, respiratory distress syndrome, sepsis, convulsion, and perinatal death were also reported. Results: Gestational age at delivery ?28 weeks' gestation was in 21.9% of the cases. Forty-three patients (67.2%) had no antenatal care. Acute renal failure (25%), pulmonary complications (25%), and eclampsia (23.4%) were the most common complications. There were five maternal deaths in 64 patients with HELLP syndrome. The most common primary cause of maternal death was multiple organ failure. All of the maternal deaths had platelet level less than 50 000 per ?l. Fetal and neonatal mortality rates were 18.8% and 20.3%, respectively. Discussion: We concluded that the incidence of serious maternal and fetal morbidities and mortalities are increased in HELLP syndrome. For this reason adequate and prompt diagnosis and management is crucial in patients with HELLP syndrome.