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To analyze the variations between maternal complications and perinatal outcome among women with complete hemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome, partial HELLP syndrome, and women with severe pre-eclampsia and normal laboratory tests. We also examine the effect of corticosteroid therapy for treatment of HELL...
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... We noted also that vaginal delivery, NICU admission rate, prevalence of IUFD and lower mean birth weight tended to be higher in the group with c-HELLP syndrome. This pattern was also seen in other studies [5,10,[17][18][19]. This might indicate that c-HELLP tends to be more severe and affects the uteroplacental blood supply more, thus mandating delivery at an earlier gestational age. ...
... The risks are highest in patients with a history of severe or early preeclampsia [29]. On the other hand, data on the longterm consequences of HELLP syndrome in its two forms are limited and, when available, are confined to c-HELLP and limited to a maximum of 5 years of follow-up [6,19,22,23]. This bestows merit on our study for filling this informational gap, with a mean of 16 years of followup (range 7-25 years). ...
To compare short-term outcomes at index and subsequent pregnancies, as well as the long-term medical complications encountered later than 5 years after index pregnancy incomplete and partial HELLP syndromes. Pregnancies complicated by partial HELLP or complete HELLP during a period of 19 years were identified. Searches were limited to cases before 2012 to ensure an adequate follow-up period. Data on index or subsequent pregnancies occurring at our center were extracted from the hospital database, while data pertaining to subsequent obstetric outcomes when deliveries occurred elsewhere together with current medical conditions were acquired by patient self-reporting. Complete HELLP was defined as the presence of the 3 components of the syndrome whereas partial HELLP was defined by the presence of 1 or 2 components. 100 pregnancies were included. At index pregnancy, there was a higher rate of composite adverse maternal outcome in complete HELLP when compared to partial HELLP (45.8% vs 21.1%, p = 0.017). Outcomes at subsequent pregnancies showed no difference between the two variants of HELLP syndrome. When examined years later, a higher frequency of “composite medical morbidity” in the complete HELLP group was observed, though this difference did not reach statistical significance (77.7% vs 61.9%, p = 1.00). Although partial HELLP is relatively less harmful, it can nonetheless cause serious maternal complications including ruptured liver hematoma, intracranial hemorrhage and even mortality. These two clinical entities represent a continuum of the same pathology, which implies that the approach at management should be uniform. Furthermore, the prognosis and long-term outcomes were not different between these 2 variants.
... The literature search yielded 546 articles, with 11 studies identified according to the inclusion criteria ( Fig. 1) [4,7,8,[14][15][16][17][18][19][20][21]. The characteristics of these included studies were summarized in Tables 1 and 2. These studies were performed from 1993 to 2011 with sample sizes ranging from 60 to 1099. ...
... The patients were divided into HELLP syndrome group and no HELLP syndrome group and the study was conducted between the two groups. The studydesign types were as follows: retrospective studies 9 items [7,8,14,15,[17][18][19][20][21], and prospective studies 2 items [4,16]. ...
... Eight studies reported 79 cases of AKI in 556 Pregnant women with HELLP syndrome and 58 cases of AKI in 1158 pregnant women without HELLP syndrome, producing a 4.87 fold (95% CI 3.31 to 7.17, P = 0.000) higher likelihood in pregnant women with HELLP syndrome [7,8,[14][15][16][17][18][19], with Very low evidence of heterogeneity (I2 = 0%, P = 0.429 Fig. 2). ...
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.
... The literature search yielded 340 articles, with 11 studies identi ed according to the inclusion criteria ( Fig.1). [1,2,[8][9][10][11][12][13][14][15][16]. Table 1-2 summarized the characteristics of these included studies. ...
... The primary disease in all the studies was gestational hypertension, the patients were divided into HELLP syndrome group and no HELLP syndrome group and the study was conducted between the tow groups. The study-design types were as follows: retrospective studies 9 items [1, 2, 8, 9, 11-13, 15, 16], and prospective studies 2 items [10,14] [1,[9][10][11] with Very low evidence of heterogeneity (I2 = 0%, P = 0.616 Fig. 3). 8 studies reported 87 cases of stillbirth in 612 Pregnant women with HELLP syndrome and 163 cases of stillbirth in 1997 Pregnant women without HELLP syndrome [8][9][10][11][13][14][15][16], producing a 1.56 fold (95% CI 1.45 to 2.11, P = 0.005) higher likelihood in Pregnant women with HELLP syndrome compared with those without HELLP syndrome with Very low evidence of heterogeneity (I2 = 12.4%, P = 0.333 Fig. 4). ...
... The study-design types were as follows: retrospective studies 9 items [1, 2, 8, 9, 11-13, 15, 16], and prospective studies 2 items [10,14] [1,[9][10][11] with Very low evidence of heterogeneity (I2 = 0%, P = 0.616 Fig. 3). 8 studies reported 87 cases of stillbirth in 612 Pregnant women with HELLP syndrome and 163 cases of stillbirth in 1997 Pregnant women without HELLP syndrome [8][9][10][11][13][14][15][16], producing a 1.56 fold (95% CI 1.45 to 2.11, P = 0.005) higher likelihood in Pregnant women with HELLP syndrome compared with those without HELLP syndrome with Very low evidence of heterogeneity (I2 = 12.4%, P = 0.333 Fig. 4). There is not enough evidence that Pregnant women with HELLP syndrome are associated with an increased incidence of Neonatal death (OR, 1.41; 95% CI 0.94 to 2.13; P = 0.098 ( Fig. 5). ...
Background
HELLP syndrome is a common complication during pregnancy,especially among those who with gestational hypertension. At present, the impact of HELLP syndrome on AKI（acute kidney injury） and maternal and infant outcomes is controversial. Thus, we conducted a meta-analysis to find out more about the relationship between HELLP syndrome and acute kidney injury during pregnancy and pregnancy outcomes.
Methods
We systematically searched PubMed , Embase and Cochrane Databases for cohort studies to assess the effect of HELLP syndrome on P-AKI(acute kidney injury in pregnancy) and maternal and infant outcomes. Using odds ratio (OR) with 95% confidence interval (CI) were pooled with a random- or fixed-effect models when appropriate.
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 has been associated with relatively higher risk of AKI during pregnancy（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 has been associated with relatively higher risk of P-AKI, fetal mortality and Maternal death .
... Laboratuvar özellikleri açısından her iki gruptaki gebeleri değerlendirdiğimizde HELLP sendromunun tanı kriterleri dışında değerlendirdiğimiz hemoglobin değerinin de her iki grupta benzer olduklarını ve istatistiksel olarak anlamlı olmadığını gördük. Bulgumuzu destekleyen literatürde birçok çalışma mevcuttur (16,17,20). ...
... sadece şiddetli preeklampsi olan hastalara (%1.9) göre yüksek saptadık. Birçok çalışmada HELLP sendromunda akut böbrek yetmezliği oranının yüksek çıkması çalışmamızı desteklemektedir (20,24). ...
... Martin ve ark.nın yaptığı çalışmada yara yeri enfeksiyonu (özellikle de C/S sonrası), HELLP sendromunda daha yüksek bulunmuştur (24). Bir başka çalışmada DİK ve dekolman plasenta oranı çalışmamızdan farklı olarak HELLP sendromunda yüksek bulunmuş, ancak pulmoner ödem, intraserebral hemoraji ve maternal mortalite çalışmamıza benzer şekilde her iki grup arasında benzer oranda izlenmiştir (20). Görüldüğü üzere ciddi maternal komplikasyonlar çalışmalara göre değişebilmekle birlikte hepsinde HELLP sendromuyla daha ilişkili bulunmuştur ve HELLP sendromu vakaları maternal mortalite ve morbiditenin önemli bir nedeni olmaya devam etmektedir. ...
Amaç: Şiddetli preeklamsiye eşlik eden HELLP (hemoliz,yükselmiş karaciğer enzimleri,düşük trombosit sayısı) sendromu olguları ile HELLP sendromu olmaksızın sadece şiddetli preeklamsi olgularında maternal ve perinatal sonuçların karşılaştırılmasıdır.Gereç ve Yöntemler: Hastanemizde 2015 Ocak ile 2018 Temmuz tarihleri arasında takip edilerek doğumu gerçekleşen şiddetli preeklampsi tanısı alan gebeler (Grup 1) ile şiddetli preeklampsiye eşlik eden HELLP sendromu tanısı alan gebeler (Grup 2) retrospektif olarak değerlendirildi. Her iki gruptaki gebelerde intruterin gelişme geriliği, preterm doğum, dekolman plasenta ve fetal ölüm gibi komplikasyonların yanında maternal morbidite ve mortalite artışına sebep olabilen durumlar ile hematolojik ve biyokimyasal parametreler açısından karşılaştırıldı.Bulgular: 2015 Ocak ile 2018 Temmuz arasında hastanemizde toplam 8730 doğum gerçekleşti ve 154 (%1.7) gebeye şiddetli preeklampsi (Grup 1), 38 (%0.4) gebeye ise şiddetli preeklampsi+HELLP (Grup 2) sendromu tanısı konuldu. Grup 1’de intrauterin gelişme geriliği 22 (%14.2), dekolman plasenta 8 (%5.2), preterm doğum %32.4 oranında görülürken, Grup 2’de ise bu oranlar sırasıyla 7 (%18.4), 3 (%7.8) ve % 26.3 olarak bulundu ve gruplar arasında anlamlı fark bulunmadı. Fetal ölüm oranları (%1.2’ye %5.2) ve sezaryen doğum oranları (%77.2’ye %86.8) açısından da gruplar açısından anlamlı fark bulunmamasına rağmen oranlar Grup 2’de daha yüksekti. Akut böbrek yetmezliği, dissemine intravasküler koagülasyon, yoğun bakım ihtiyacı ile kan ve kan ürünü transfüzyonu ihtiyacı da Grup 2’de daha fazla bulundu ve gruplar arasında istatistiksel anlamlı fark tespit edildi. Sonuç: Şiddetli preeklampsi ve özellikle şiddetli preeklampsiye eşlik eden HELLP sendromu varlığı perinatal komplikasyonların yanında ciddi maternal morbidite ve mortalite artışı ile birliktelik göstermekte olup mümkün olan en kısa zamanda gebeliğin sonlandırılması ve uygun destek tedavisinin verilmesi gerekmektedir.
... The neonatal deaths were 4 cases (20%) in comparison to Sibai BM (33.3%), [6] Magann EF et al (23.2%), [7] Liu et al (42%), [8] Visser W (14.1%) [9] and Sowjanya et al (35.33%). ...
... In the opinion of Turgut et al (2010), HELLPs patients experience the increasing of morbidity and mortality. Liu et al (2006) stated that the maternal mortality rate between the HELLPs and non-HELLPs group show no difference. In this study, no mortality found in the HELLPs group, while one patient in non-HELLPs. ...
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.
... Çalışmamızda postpartum eklampsi oranları şiddetli preeklampsi(%2,9) ve HELLP sendromunda (%2,3) benzer olarak bulunmuştur. Bazı çalışmalarda HELLP Sendromunda eklampsinin daha sık izlendiği belirtilmiştir [17,18]. Çalışmamızda yenidoğan bebeklerde hiperbilurubinemi her üç grupta da anlamlı olarak yüksek bulunmuştur. ...
Aim: The purpose of this study was to investigate the association between maternal-fetal outcomes and the severity of preeclampsia. Material and Method: A total of 528 singleton pregnancies diagnosed with preeclampsia, severe preeclampsia or HELLP syndrome with pregnancies >24 weeks of gestation were retrospectively evaluated. For each patient, maternal age, gravidity, previous obstetric history, family history, gestational age at the time of hospitalization, systolic and diastolic blood pressures, presence of severe preeclampsia symptoms, laboratory values, dexamethasone use for the treatment of thrombocytopenia, route of delivery, maternal and perinatal outcomes were recorded. Results: Within the study period, the occurences of preeclampsia, HELLP syndrome and severe preeclampsia were 1.4%, 0.12% and 0.57%, respectively. In patients with HELLP syndrome, cesarean delivery rate, blood product transfusion, acute renal failure, liver function tests, D-dimer levels, neonatal respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), preterm retinopathy, pulmonary hemorrhage and sepsis occurrences, were significantly higher than in patients with mild and severe preeclampsia. On the contrary, platelet counts were significantly lower . In patients with mild preeclampsia, gestational age at the time of delivery, vaginal delivery rate, 1 and 5 minute APGAR score and newborn birthweight were significantly higher when compared to patients with severe preeclampsia or HELLP syndrome. In contrast, systolic and diastolic blood pressures, neonatal intensive care unit admission rate, hospital stay, protein levels in 24 hr urine, and maternal hemoglobin levels were significantly lower in this group. Discussion: In the present study, it was found that HELLP syndrome was more frequently associated with maternal complications and neonatal morbidities. For the prevention of morbidities due to these unpredictable syndromes with unclear etiologies, pregestational medical evaluation and regular antenatal follow-up visits especially for high-risk women should be emphasized. Whenever possible, women diagnosed with severe preeclampsia or HELLP syndrome should be transferred to a tertiary medical center with adequate capabilities for maternal and neonatal intensive care in order to decrease perinatal morbidities.
... Çalışmamızda postpartum eklampsi oranları şiddetli preeklampsi(%2,9) ve HELLP sendromunda (%2,3) benzer olarak bulunmuştur. Bazı çalışmalarda HELLP Sendromunda eklampsinin daha sık izlendiği belirtilmiştir [17,18]. Çalışmamızda yenidoğan bebeklerde hiperbilurubinemi her üç grupta da anlamlı olarak yüksek bulunmuştur. ...
Aim: The purpose of this study was to investigate the association between maternal-fetal outcomes and the severity of preeclampsia. Material and Method: A total of 528 singleton pregnancies diagnosed with preeclamp-sia, severe preeclampsia or HELLP syndrome with pregnancies >24 weeks of gestation were retrospectively evaluated. For each patient, maternal age, gravidity, previous obstetric history, family history, gestational age at the time of hospitalization, systolic and diastolic blood pressures, presence of severe preeclampsia symptoms, laboratory values, dexamethasone use for the treatment of thrombocytopenia, route of delivery, maternal and perinatal outcomes were recorded. Results: Within the study period, the occurences of preeclampsia, HELLP syndrome and severe preeclampsia were 1.4%, 0.12% and 0.57%, respectively. In patients with HELLP syndrome, cesarean deliv-ery rate, blood product transfusion, acute renal failure, liver function tests, D-dimer levels, neonatal respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), preterm retinopathy, pulmonary hemorrhage and sepsis occurrences, were significantly higher than in patients with mild and severe preeclampsia. On the contrary, platelet counts were significantly lower . In patients with mild preeclampsia, gestational age at the time of delivery, vaginal delivery rate, 1 and 5 minute APGAR score and newborn birthweight were significantly higher when compared to patients with severe preeclamp-sia or HELLP syndrome. In contrast, systolic and diastolic blood pressures, neonatal intensive care unit admission rate, hospital stay, protein levels in 24 hr urine, and maternal hemoglobin levels were significantly lower in this group. Discussion: In the present study, it was found that HELLP syndrome was more frequently associated with maternal complications and neonatal morbidities. For the prevention of morbidities due to these unpredictable syndromes with unclear etiologies, pregestational medical evaluation and regular antenatal follow-up visits especially for high-risk women should be emphasized. Whenever possible, women diagnosed with severe preeclampsia or HELLP syndrome should be transferred to a tertiary medical center with adequate capabilities for maternal and neonatal intensive care in order to decrease perinatal morbidities.
... 5 Not only is HELLPs a serious obstetric complication, but it also places the mother at increased risk of lipoprotein metabolism dysfunction later in life, 6 and is associated with severe fetal outcomes, such as prematurity, low birthweight, and still birth. 7,8 Human cytomegalovirus (CMV), a ubiquitous intracellular pathogen, is correlated with immune-compromised conditions. 9,10 During pregnancy, the maternal immune system tends to tolerate fetal-derived paternal antigens by suppressing cell-mediated immunity, which may induce a state of increased susceptibility to intracellular pathogen reactivation, such as CMV. ...
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.
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.
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.
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.
... Postpartum hemorrhage developed in four patients who had placental detachment, which was consistent with respect to other studies (11). Acute renal failure is encountered between 5 and 36 percent in patients with HELLP syndrome (3,5,7,10,12,13). The patients with postpartum HELLP syndrome have significantly higher incidences of pulmonary edema and renal failure (3). ...
... Also information about about neonatal long term survey was not possible due to the retrospective nature of the study. Maternal mortality rate is 1.1-9.0% in pregnancies complicated with the HELLP syndrome (3,6,10,12,13). Although the most reported cause of death is cerebral hemorrhage, it was stated that multiple organ failure, disseminated intravascular coagulation and adult respiratory distress are contributing pathologies (1). ...
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.
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.
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.
Neither clinical characteristics nor laboratory parameters was found effective for prediction of adverse maternal and fetal outcomes.
