Comparisons of maternal and perinatal outcomes in Taiwanese women with complete and partial HELLP syndrome and women with severe pre-eclampsia without HELLP

Effect of HELLP syndrome on acute kidney injury in pregnancy and pregnancy outcomes: a systematic review and meta-analysis

Background

HELLP syndrome may increase adverse pregnancy outcomes, though the incidence of it is not high. At present, the impact of HELLP syndrome on P-AKI (acute kidney injury during pregnancy) and maternal and infant outcomes is controversial. Thus, we conducted a meta-analysis to find out more about the relationship between HELLP syndrome and P-AKI and pregnancy outcomes.

Methods

We systematically searched PubMed, Embassy and Cochrane Databases for cohort studies and RCT to assess the effect of HELLP syndrome on P-AKI and maternal and infant outcomes. Study-specific risk estimates were combined by using fixed-effect or random-effect models.

Results

This meta-analysis included 11 cohort studies with a total of 6333 Participants, including 355 cases of pregnant women with HELLP syndrome and 5979 cases that without. HELLP syndrome was associated with relatively higher risk of P-AKI (OR4.87 95% CI 3.31 ~ 7.17, P<0.001), fetal mortality (OR1.56 95% CI 1.45 ~ 2.11, P<0.001) and Maternal death (OR3.70 95% CI 1.72 ~ 7.99, P<0.001).

Conclusions

HELLP syndrome is associated with relatively higher risk of P-AKI, fetal mortality and maternal death.

CHARACTERISTICS OF HELLP SYNDROME IN SEVERE PREECLAMPSIA PATIENTS IN DR. SOETOMO HOSPITAL SURABAYA

Hemolysis, elevated liver enzyme, and low platelet count syndrome (HELLPs) is complication following severe preeclampsia which is one of the three leading causes of maternal mortality in Indonesia. The purpose of this study was to understand the prevalence, characteristics, and post-partum outcome of HELLPs patients who deliver in Dr. Soetomo Hospital in July 2012-June 2013. This study was observational-descriptive, cross sectional study. The population observed was the severe preeclampsia patients who deliver in Dr. Soetomo Hospital and have complete medical data in July 2012-June 2013. study subject taken by total sampling. HELLPs follow the 7% of severe preeclampsia patients. The maternal average age of HELLPs group was 30.2 (19-43), while in non-HELLPs was 30.8 (17-46). Most HELLPs patients were in the first and second pregnancy. The average of gestational age at labor in HELLPs was 33-34 weeks. Both in HELLPs and non-HELLPs most performed Cesarean Section delivery. No post-partum maternal mortality found in HELLPs, but 25% had stillbirth. The average of birth weight in HELLPs was 1994.4 g. First minute Apgar score >7 was 33.3% in HELLPs group. In conclusion, Most HELLPs patients were in the first and second pregnancy, while non-HELLPs were in first pregnancy. The average of gestational age at labor was lower in HELLPs group. Neonates mortality were higher in HELLPs group. The average of birth weight was lower in HELLPs group. First minute Apgar score > 7 was higher in non-HELLP group.

CMV infection, TLR-2 and -4 expression, and cytokine profiles in early-onset preeclampsia with HELLP syndrome

PROBLEM

Cytomegalovirus (CMV) infection was previously reported in pregnancy complications. However, its seroprevalence and associated Toll-like receptor (TLR) expression in early-onset preeclampsia (EOPE) with hemolysis, elevated liver enzyme and low platelets syndrome (HELLPs) are unexplored.

METHOD OF STUDY

A case–control study was performed to examine maternal CMV antibodies, neutrophil Toll-like receptor (TLR)-2 and -4 expression as well as the cytokine profile in EOPE with HELLPs (EOPE-HELLPs) (n = 10), late-onset preeclampsia (LOPE) (n = 20), normal pregnancy (n = 60), and non-pregnancy (n = 20) controls.

RESULTS

EOPE-HELLPs had significantly increased CMV IgG sero-positivity, upregulated TLR-2/-4 mRNA expression, increased serum IL-6 and TNF-α, and reduced IL-10 compared with matched normal and non-pregnancy controls. No significant difference was observed between LOPE and normal pregnancy controls.

CONCLUSION

We observed a significant association between CMV IgG sero-positivity and innate immune response in EOPE-HELLPs. Our data suggest that CMV infection may be a risk factor for this disorder.

Do clinical and laboratory parameters effect maternal and fetal outcomes in pregnancies complicated with hemolysis, elevated liver enzymes, and low platelet count syndrome?

OBJECTIVE

The aim of the study was to investigate whether the clinical features and laboratory parameters affect maternal and fetal outcomes in pregnancies complicated with HELLP syndrome.

MATERIAL AND METHODS

The medical records of pregnant patients complicated with HELLP syndrome were analyzed retrospectively between June 01, 2003 and June 01, 2010. The demographic data, medical history, admission symptoms, clinical and laboratory findings and recovery time were evaluated. The adverse maternal outcomes including eclampsia, placental abruption, disseminated intravascular coagulation, postpartum hemorrhage, pulmonary complications, cerebral edema and visual loss were recorded. Fetal growth restriction, necessity for neonatal intensive care unit admission and perinatal mortality were recorded as an adverse fetal outcome.

RESULTS

The incidence of HELLP syndrome was 0.52%. The mean age of the patients was 28.93±7.90 (range 17-45). HELLP syndrome was diagnosed on average in the 33.68±4.41(th) (ranged 24-40) week of gestation. Eighteen cases (40.9%) were nullipara and twenty-six cases (59.1%) multipara. The most common complications were eclampsia (40.9%) and abruption placenta (15.9%). Pregnancy was terminated within 48 hours in all patients. The rate of cesarean section was 90.9%. Perinatal mortality rate in HELLP syndrome was 31.8%. There was no maternal mortality.

CONCLUSION

Neither clinical characteristics nor laboratory parameters was found effective for prediction of adverse maternal and fetal outcomes.

Are maternal and fetal parameters related to perinatal mortality in HELLP syndrome?

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.