Surveillance of HELLP syndrome

Summary

HELLP is an important complication of pregnancy, characterised by haemolysis, elevated liver enzymes and low platelets. Women may be managed with expedited delivery or expectant management, but it is not clear to what extent expectant management is used in the UK and the outcomes for mothers and babies. The aim of this study, using the UK Obstetric Surveillance System (UKOSS) was to describe the current management and outcomes of HELLP syndrome in the UK.One hundred and nine women were identified with HELLP syndrome. 69 women (63%) were diagnosed with HELLP syndrome antenatally at a median gestation of 35 weeks (range 21-41). 54%(37/68) of antenatally diagnosed women had a planned management of immediate delivery and delivered a median of 3h 37min after diagnosis (range 53min-21h 26min); 43%(29/68) had a planned management of delivery within 48h and delivered a median of 11h 40min after diagnosis (range 1h 28min–74h 43min); only 2/68 had a planned attempt at expectant management, with one delivering 3 days and the other 12 days after diagnosis. Severe morbidity was noted in 15%(16/109) of the women and one woman died (case fatality 0.9%, 95%CI 0.02-5.0%). Major complications were reported in 9%(10/108) of infants and there were two perinatal deaths (perinatal mortality rate 18 per 1,000 total births, 95%CI 2-62). All cases associated with major maternal or perinatal complication occurred in women delivered within 48h of diagnosis or in women diagnosed postpartum. This study shows that HELLP syndrome is associated with severe maternal and perinatal morbidity. Expectant management is rarely used in the UK.

Publications

Journal Articles

• Fitzpatrick KE, Hinshaw K, Kurinczuk JJ, Knight M. Risk factors, management, and outcomes of hemolysis, elevated liver enzymes, and low platelets syndrome and elevated liver enzymes, low platelets syndrome. Obstet Gynecol. 2014;123(3):618-27.