Factors relevant to mode of preterm delivery with syndrome of HELLP (hemolysis, elevated liver enzymes, and low platelets)

HELLP syndrome

HELLP syndrome is a serious, life-threatening form of pre-eclampsia with a typical laboratory triad. The incidence of the disease is reported as being 0.17-0.85% of all live births. There has been, to date, neither reliable early recognition nor effective prevention of HELLP syndrome. As a result of endothelial dysfunction, activation of intravascular coagulation occurs with fibrin deposition in the capillaries and consecutive microcirculation disorders. The disease manifests itself on average between 32-34 weeks' gestation. HELLP syndrome will occur postpartum in up to 30% of the cases. The clinical cardinal symptom of the disease is right upper quadrant pain or epigastric pain accompanied with nausea, vomiting and malaise. In 20% of the cases with HELLP syndrome there is no hypertension and 5-15% of the pregnant patients present a low level of proteinuria or none at all. The early recognition of hemolysis is most sensitively managed by the determination of the serum haptoglobin. The increase of the aspartate transaminase (AST) and the alanine transaminase (ALT) often precedes a decrease in platelets. The course of HELLP syndrome is incalculable. It is universally agreed that a pregnancy from 32-34 weeks should be immediately delivered. Before 32-34 weeks, expectant management is generally possible in a perinatal center. The frequency for a repeated hypertensive disease in pregnancy ranges from 27% to 48%.

Maternal and neonatal outcome in early- and late-onset pre-eclampsia

Early-onset pre-eclampsia and late-onset pre-eclampsia, by virtue of their unpredictable nature and prediliction for multi-organ involvement, are associated with substantial maternal and fetal morbidity and mortality. Recent years have seen the introduction of the concepts of care in specialized units, expectant management of pre-eclampsia, conservative management of the HELLP syndrome (haemolysis, elevated liver enzymes, low platelets), usage of magnesium sulphate and improved feto-maternal surveillance. It is important to note that these factors also influence maternal and neonatal outcome.