Pregnancy and severe chronic hypertension: maternal outcome.

OBJECTIVE: To determine the maternal outcome associated with severe chronic hypertension during the second half of pregnancy. METHODS: An analysis of data obtained of women with severe chronic hypertension (> or = 160/110 mm Hg) and > or = 20 weeks' gestation who were hospitalized and delivered during a 5-year period. The pregnancy outcome data were collected retrospectively from medical records. Each patient was observed closely throughout hospitalization with intensive monitoring of the clinical status of both mother and fetus. Antihypertensive drugs were used for systolic or diastolic blood pressure > or = 160 and > or = 110 mm Hg, respectively. Women with superimposed preeclampsia received magnesium sulfate. The main outcome measures were peak of blood pressure, superimposed preeclampsia, and major maternal complications. RESULTS: Of 154 women studied, 111 (72%) had pregestational chronic hypertension, and 120 (78%) developed superimposed preeclampsia. The mean weeks' gestation was 34.5 +/- 4.6. Overall, 110 (71.4%) pregnancies were delivered by cesarean section. Maternal age and parity were significantly higher among women who had pregestational chronic hypertension than those who had chronic hypertension diagnosed during the first half of pregnancy. Abruptio placentae (8.4%), HELLP syndrome (8.4%), acute renal insufficiency (3.9%), pulmonary edema (1.3%), and postpartum hypertensive encephalopathy (1.3%) were the most frequent maternal complications. There were no maternal deaths, disseminated intravascular coagulation, or eclampsia. CONCLUSION: Three-quarters of women with severe chronic hypertension in the second half of pregnancy developed superimposed preeclampsia. Intensive monitoring of the clinical status of the mother was associated with low maternal morbidity and the absence of maternal deaths. Pregestational chronic hypertension does not change the maternal prognosis.     

Neonatal outcome in pregnancies after preterm delivery for HELLP syndrome

OBJECTIVE: To compare neonatal outcome after preterm delivery of infants where pregnancy had been complicated by the HELLP syndrome. STUDY DESIGN: The maternal and neonatal charts of 475 consecutive pregnancies complicated by hypertensive disorders at our perinatal unit were reviewed. The HELLP syndrome was defined by previously published laboratory criteria. 93 women fulfilled the criteria and constituted our HELLP syndrome study group. 188 normotensive patients who were delivered because of preterm labor comprised the control group. Results were compared by means of chi2 analysis and Student's t test where appropriate. RESULTS: There were 518 pregnancies complicated by hypertensive disorders and 93 by HELLP syndrome. The incidence of HELLP syndrome among women with severe preeclampsia was 19.5%. We found a significant difference in the incidence of intrauterine growth restriction (61.2 vs. 5.8%, p < 0.0001), intrauterine fetal death (13.9 vs. 6.9%, p = 0.035), abruptio placenta (13.9 vs. 2.6%, p = 0.001), and fetal distress (35.4 vs. 12.2%, p < 0.0001) between the two groups. There were no significant differences in complications (respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis and sepsis) between the HELLP syndrome group and controls. However, the neonatal death rate and the need for mechanical ventilation and neonatal intensive care were greater in the HELLP syndrome group. CONCLUSIONS: Our study suggests an increased mortality and morbidity in newborns of mothers complicated with HELLP syndrome that can be partly attributed to increased rates of intrauterine growth restriction and fetal distress, particularly beyond 32 weeks of gestation.     

Expectant management of severe preeclampsia and preeclampsia superimposed on chronic hypertension between 24 and 34 weeks' gestation

BACKGROUND: Timing of delivery is difficult to judge in preeclampsia. OBJECTIVE: To compare the differences of maternal and perinatal outcome of patients with severe preeclampsia and essential hypertension with superimposed preeclampsia, with expectant management at 24-34 weeks' gestation. STUDY DESIGN: A retrospective review of a conservative regime using intravenous magnesium sulfate, glucocorticoids and antihypertensive drugs, monitored by serial liver function tests, full blood count, coagulation profile, and renal function tests. Fetal status was assessed by daily non-stress test and ultrasound twice by week. RESULTS: A total number of 100 women had severe preeclampsia and 29 superimposed preeclampsia. The average pregnancy prolongation was 8.4 and 8.5 days, respectively. Oliguria, abruption placentae and HELLP syndrome were frequent complications similar in each group. There were no cases of eclampsia or disseminated coagulopathy in either group. The total neonatal survival rate was 93% in both groups. CONCLUSION: Expectant management is equally safe in both superimposed preeclampsia and severe preeclampsia of early onset.     

Risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome

OBJECTIVE: This study was undertake to determine risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. STUDY DESIGN: Maternal medical records of pregnancies complicated by HELLP syndrome managed between July 1, 1992, and April 30, 1999, were reviewed. Risk factors evaluated included maternal age, parity, race, previous preeclampsia, chronic hypertension, gestational age at diagnosis, mean arterial blood pressure, nadir blood platelet count (<50,000 cells/microL vs > or =50,000 cells/microL), and peak serum levels of aspartate aminotransferase and lactate dehydrogenase. Maternal outcome variables analyzed included eclampsia, abruptio placentae, disseminated intravascular coagulopathy, pulmonary edema, pleural effusion, ascites, acute renal failure, liver hematoma, need for transfusion of blood products, cesarean delivery, and death. Statistical analysis was performed with the Student t test, the chi(2) test, and logistic regression analysis. RESULTS: A total of 183 women with HELLP syndrome were studied. Eclampsia was present in 6%, abruptio placentae was present in 10%, and disseminated intravascular coagulopathy was present in 8%. Forty-one women (22%) required transfusion of blood products. Incidence of eclampsia significantly decreased with increasing gestational age, from 16% at < or =28 weeks' gestation to 3% at >32 weeks' gestation (P <.05) and was higher among African American patients than among white patients (12% vs 3%; P <.05). Logistic regression analysis showed an independent relationship between eclampsia and race (P <.05). Incidence of abruptio placentae was higher among women with previous preeclampsia than among women without this clinical history (26% vs 5%; P <.05). Disseminated intravascular coagulopathy was significantly associated with abruptio placentae (P <.0001) and acute renal failure (P <.0001). A nadir platelet count of <50, 000/microL, a peak serum aspartate aminotransferase level of >150 U/L, and a peak serum lactate dehydrogenase level of >1400 U/L were not independent risk factors for adverse outcome. CONCLUSIONS: Among women with HELLP syndrome, African American race is a risk factor for eclampsia. Both acute renal failure and abruptio placentae are associated with disseminated intravascular coagulopathy. Laboratory parameters of HELLP syndrome are not independent risk factors for adverse maternal outcome.     

慢性高血压并发子痫前期的母儿结局分析

目的 了解慢性高血压并发子痫前期与非慢性高血压并发子痫前期患者的临床特征和母儿结局.方法 回顾分析2009年1月1日至2017年12月31日在广州医科大学附属第三医院住院分娩的妊娠≥20周的单胎妊娠诊断为子痫前期的病例资料.按是否为慢性高血压分为慢性高血压并发子痫前期组及非慢性高血压并发子痫前期组,分析两组的临床特征与...     

Expectant management of preeclampsia superimposed on chronic hypertension

Objective.?Women with chronic hypertension (CHTN) are at an increased risk for pregnancy complications including preeclampsia. The objective of this study was to review pregnancy outcomes for women with expectant management of preeclampsia superimposed on CHTN prior to 37 weeks'.

Methods.?We reviewed the inpatient charts of all women admitted to Magee-Womens Hospital (1995–2005) with the diagnosis of both CHTN and preeclampsia prior to term.

Results.?Sixty-eight women diagnosed with both CHTN and preeclampsia prior to 37 weeks' were identified. Of these, 42 women were expectantly managed; one subject was excluded from analysis for pregestational diabetes. For the remaining 41 women, the median gestational age at diagnosis was 31.6 weeks (range 23.6–36.4). The mean time from diagnosis to delivery was 9.7 days (range 2–34 days). Adverse perinatal outcomes included one case of HELLP syndrome, two cases of placental abruptions, three cases of pulmonary edema, and five postpartum hemorrhages. There were no fetal/neonatal or maternal deaths. Average NICU stay was 17.9 days.

Conclusions.?Expectant management of preterm superimposed preeclampsia among women with CHTN is a reasonable management strategy, but associated with some maternal morbidity. Prospective studies are needed to definitively quantify the risks and benefits of this approach.     

A review of HELLP syndrome.

HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is a variant of severe preeclampsia which is associated with substantial maternal and perinatal morbidity and mortality. As with preeclampsia, the etiology and pathogenesis of HELLP syndrome is not completely understood. An increase in vascular thrombosis and activation of the coagulation system may be important in the clinical presentation of this disorder. Laboratory criteria for the diagnosis of HELLP syndrome have been classically described but lack uniformity among different institutions. Aggressive management of HELLP syndrome with expeditious delivery appears to yield the lowest perinatal mortality rates. Conservative or expectant management has been associated with higher stillbirth rates with antenatal corticosteroids not causing resolution of the laboratory abnormalities. Resolution of laboratory abnormalities in HELLP syndrome runs a protracted course over several days after delivery. Despite nearly two decades since HELLP syndrome has been defined as a clinical entity, treatment for the disorder still remains delivery of the patient.     

HELLP综合征14例临床分析

目的 探讨产科并发症HELLP综合征的母儿预后。方法 回顾性分析研究14例HELLP综合征的患者妊娠结局和围产儿预后。结果 14例中12例发生在产前，2例发生在产后，平均孕龄为32．5周，孕妇的严重并发症包括：急性肾衰、DIC、肺水肿、严重腹水和胎盘早剥等。其中8例需要输血或血液制品，12例采用剖宫产结束分娩。围产儿死亡5例，主要与胎盘早剥有关，另外胎儿宫内窘迫及早产也是重要原因。结论 HELLP综合征是一种严重的产科并发症，其高的母婴并发症和病死率要求我们对有妊娠高血压疾病的患者进行密切随访和治疗，一旦确诊为HELLP综合征应转入中心级以上医院进行治疗，尽快终止妊娠。     

Doppler sonographic findings for hypertension in pregnancy and HELLP syndrome

Doppler examinations of the umbilical artery, both uterine arteries, and the fetal middle cerebral artery were performed in the third trimester in 18 patients with pregnancy induced hypertension, 52 patients with preeclampsia, and 32 patients with HELLP syndrome and the results were correlated with the parameters fetal outcome. For 74% of the patients this was the first pregnancy, in 93% of the cases a cesarean section was necessary; 66% of the newborn babies were dystrophic and 90% of them were born prematurely. The blood flow in one uterine artery was restricted in 95% of all 102 pregnant women, only 5% did not show any pathological findings. A pathological blood flow was observed on Doppler sonography in the umbilical artery in 70% of the group and 39% showed a pathologically increased perfusion of the fetal middle cerebral artery. The average birth weights and gestational ages in the study group were markedly reduced in comparison with healthy pregnant women (pregnancy induced hypertension: 1620 g/35 weeks; preeclampsia: 1660 g/34 weeks; HELLP syndrome: 1160 g/31 weeks, respectively). The lowest values for average birth weight and gestational age occurred when all four investigated blood vessels showed pathological Doppler findings: 1180 g/31 weeks (0 to 1 pathological vascular findings: 2780 g/38 weeks; 2 pathological vascular findings: 1845 g/34.5 weeks; 3 pathological vascular findings: 1330 g/31 weeks). This Doppler study underlines the importance of examining four blood vessels: the uterine, the umbilical, and the fetal middle cerebral arteries for a complete analysis of the fetoplacental hemodynamics. On account of the severely impaired hemodynamics observed in the placentas of our patients with hypertensive diseases in pregnancy or HELLP syndrome, we believe the early diagnosis of these disorders by Doppler sonography and an early start of therapy to be essential.     

HELLP syndrome in pregnancies below 26th week

Objective: To test the hypothesis that HELLP syndrome may be more likely to develop earlier, if a pregnant woman has aPL antibodies, and to observe clinical and laboratory factors preceding the occurrence of HELLP syndrome. Materials and methods: The study consisted in retrospective analysis, with updated verification, of HELLP syndrome in pregnancies below 26th week in our clinic in the years 1992–2010. Results: HELLP syndrome, if it occurred before the 26th week, occurred only in women with preeclampsia superimposed on chronic hypertension and in women with aPL antibodies. HELLP syndrome with aPL antibodies occurred with low level of platelets (mean 35.5?×?10⁹/L), lower level of AT III (mean 71.3%), lymphopenia, higher CRP (mean 9.1) and pale infarct of placenta (100%). The occurrence of HELLP syndrome was always preceded by surges in blood pressure resistant to antihypertensive drugs. Conclusion: HELLP syndrome in early pregnancy may indicate the presence of aPL antibodies. It may also be a clinical symptom of APS. A surge in blood pressure is a clinical forerunner of the coming HELLP syndrome. HELLP syndrome in women with APS is characterized by low level of platelets.     

Perinatal outcomes in severe preeclampsia-eclampsia with and without HELLP syndrome

OBJECTIVE: Our purpose was to find out and compare perinatal outcomes in pregnancies complicated by severe preeclampsia-eclampsia with and without HELLP syndrome. METHODS: Clinical and laboratory findings, and perinatal-neonatal outcomes of all pregnants with severe preeclampsia, eclampsia and HELLP have been prospectively recorded. Results were compared by means of Student's t test, chi2 analysis and Fisher's exact test as appropriate. RESULTS: Among 367 consecutive severe preeclampsia, 106 (29%) had HELLP syndrome, 261 (71%) had severe preeclampsia and eclampsia. Mean gestational age and birth weight at delivery in severe preeclampsia without HELLP syndrome and in HELLP syndrome were 34.1 +/- 6.1 vs. 33.0 +/- 5.8 weeks (p = 0.119) and 1,886 +/- 764 vs. 1,724 +/- 776 g (p = 0.063), respectively. Comparing overall fetal mortality (4.6 vs. 10.3%, p = 0.009) and perinatal mortality (8.0% vs. 16.8%, p = 0.026) in severe preeclampsia-eclampsia and HELLP syndrome, respectively, there were statistically significant differences. But when analyses were performed according to gestational age before and after 32nd gestational week, the difference of perinatal mortality between the two groups was non-significant (p = 0.644 and p = 0.250), suggesting borderline difference. The most common contributing factor for fetal death after 32nd week was due to abruptio placenta without prenatal follow-up. Neonatal morbidity and neonatal mortality (4.8 vs. 6.3%, p = 0.905) in severe preeclampsia-eclampsia and HELLP syndrome respectively were similar and the difference was statistically nonsignificant. CONCLUSIONS: Perinatal mortality and neonatal morbidity-mortality according to gestational age before and after the 32nd week were similar in HELLP syndrome compared with severe preeclampsia-eclampsia without HELLP but overall fetal mortality was higher in HELLP syndrome with no regular prenatal care.     

Severe preeclampsia is associated with a positive family history of hypertension and hypercholesterolemia.

OBJECTIVE:To investigate an association between a family history of cardiovascular disease and severe preeclampsia and/or HELLP syndrome (Haemolysis, Elevated Liver enzymes, Low Platelets). METHODS: One hundred twenty-eight women with a history of severe preeclampsia and/or HELLP syndrome and 123 women with previous uncomplicated pregnancies only were included in the study. All participants completed questionnaires about diagnoses of cardiovascular diseases, hypertension, and hypercholesterolemia among their first-degree relatives, which were subsequently confirmed by the relatives' general practitioners. The main outcome measures were the prevalence of cardiovascular diseases, hypertension, and hypercholesterolemia among first-degree relatives of both groups. Statistical analysis was done using chi(2)-analysis. RESULTS:The prevalence of familial cardiovascular disease among women with a history of severe preeclampsia and/or HELLP syndrome (23%) compared to controls (19%) was not significantly different (OR 1.3, 95%CI 0.7-2.5). However, women with a history of severe preeclampsia and/or HELLP syndrome more often had one or more first-degree relatives with hypertension and/or hypercholesterolemia before the age of 60 years compared to controls (54% vs. 32%, respectively; OR 2.6, 95%CI 1.5-4.3). The prevalence of hypertension and hypercholesterolemia among first-degree relatives, irrespective of age, also was significantly higher among women with a history of severe preeclampsia and/or HELLP syndrome as compared to controls (60% vs. 42%, respectively; OR 2.0, 95%CI 1.2-3.4). CONCLUSION:Severe preeclampsia is associated with a positive family history of hypertension and/or hypercholesterolemia.     

Treatment of severe preeclampsia and HELLP syndrome

Severe preeclampsia and HELLP syndrome are still one of the leading causes of maternal and perinatal morbidity and mortality. The current definitions of the diseases should be considered before treatment. The timely allocation to a perinatal center and an intensive monitoring of mother and child after admission are mandatory for successful management of these patients. The aim of therapy is immediate stabilization of the mother's condition by means of anticonvulsive prophylaxis with intravenous magnesium sulphate, well-controlled reduction of blood pressure by the administration of urapidil or nifedipine, controlled volume expansion and an adequate treatment of coagulation disorders by giving fresh frozen plasma (not heparin).Immediate delivery is the method of choice in cases of severe preeclampsia/HELLP syndrome > or = 34 weeks' gestations; we prefer cesarean section in patients with an unripe cervix and the full-blown picture of HELLP syndrome. In patients < 34 weeks' gestation expectant management is generally possible under intensive monitoring of the mother and the fetus. Maternal and fetal indications for immediate termination of pregnancy should be considered carefully. The systemic application of corticosteroids is a promising approach to prolong pregnancy. During the past decade the increasing awareness of obstetricians and other disciplines have led to a significant reduction of maternal mortality (< 1 %) and perinatal mortality (9.4-16.2 %) in cases of HELLP syndrome, in particular in the West European countries.     

HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome versus severe preeclampsia: onset at < or =28.0 weeks' gestation

OBJECTIVE: Our purpose was to determine whether the onset of the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome in women at < or =28.0 weeks' gestation is associated with an increased risk of adverse maternal and perinatal outcomes in comparison with the risk for women with severe preeclampsia but without the HELLP syndrome at a similar gestational age. STUDY DESIGN: Sixty-four patients with either the HELLP syndrome (n = 32) or severe preeclampsia but absent HELLP syndrome laboratory test results (n = 32), admitted at < or =28.0 weeks' gestation between July 1, 1992, and April 30, 1999, were studied. Maternal and perinatal outcomes were compared between the 2 groups. Statistical analysis was performed by the Student t test and the Fisher exact test. RESULTS: There were no significant differences between the 2 groups regarding African-American race (59% vs 75%), nulliparity (50% vs 56%), or the use of corticosteroids (59% vs 78%). There were no maternal deaths. One woman with the HELLP syndrome had a liver hematoma. The rate at which transfusion of blood products was required was significantly greater in women with the HELLP syndrome than in those with severe preeclampsia only (25% vs 3%; P <.05). There were no significant differences between the 2 groups with respect to eclampsia (16% vs 13%), abruptio placentae (6% vs 9%), disseminated intravascular coagulopathy (13% vs 0%), pulmonary edema (13% vs 6%), acute renal failure (3% vs 0%), pleural effusion (3% vs 3%), or ascites (6% vs 16%). No significant differences were found between the 2 groups with respect to neonatal death (11% vs 17%), respiratory distress syndrome (78% vs 86%), or composite neonatal morbidity. CONCLUSIONS: Except for the need for transfusion of blood products in women with the HELLP syndrome, onset at < or =28.0 weeks' gestation is not associated with an increased risk of adverse maternal or neonatal outcomes in comparison with the risk for women with severe preeclampsia but without the HELLP syndrome at a similar gestational age.     

HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome versus severe preeclampsia: Onset at ≤28.0 weeks’ gestation

Objective: Our purpose was to determine whether the onset of the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome in women at ≤28.0 weeks’ gestation is associated with an increased risk of adverse maternal and perinatal outcomes in comparison with the risk for women with severe preeclampsia but without the HELLP syndrome at a similar gestational age. Study Design: Sixty-four patients with either the HELLP syndrome (n = 32) or severe preeclampsia but absent HELLP syndrome laboratory test results (n = 32), admitted at ≤28.0 weeks’ gestation between July 1, 1992, and April 30, 1999, were studied. Maternal and perinatal outcomes were compared between the 2 groups. Statistical analysis was performed by the Student t test and the Fisher exact test. Results: There were no significant differences between the 2 groups regarding African-American race (59% vs 75%), nulliparity (50% vs 56%), or the use of corticosteroids (59% vs 78%). There were no maternal deaths. One woman with the HELLP syndrome had a liver hematoma. The rate at which transfusion of blood products was required was significantly greater in women with the HELLP syndrome than in those with severe preeclampsia only (25% vs 3%; P < .05). There were no significant differences between the 2 groups with respect to eclampsia (16% vs 13%), abruptio placentae (6% vs 9%), disseminated intravascular coagulopathy (13% vs 0%), pulmonary edema (13% vs 6%), acute renal failure (3% vs 0%), pleural effusion (3% vs 3%), or ascites (6% vs 16%). No significant differences were found between the 2 groups with respect to neonatal death (11% vs 17%), respiratory distress syndrome (78% vs 86%), or composite neonatal morbidity. Conclusions: Except for the need for transfusion of blood products in women with the HELLP syndrome, onset at ≤28.0 weeks’ gestation is not associated with an increased risk of adverse maternal or neonatal outcomes in comparison with the risk for women with severe preeclampsia but without the HELLP syndrome at a similar gestational age. (Am J Obstet Gynecol 2000;183:1475-9.)     

Perinatal outcomes, blood pressure patterns and risk assessment of superimposed preeclampsia in mild chronic hypertensive pregnancy

OBJECTIVE: Assessment of perinatal outcomes, blood pressure (BP) patterns and risk of superimposed preeclampsia in a population with mild chronic hypertension. STUDY DESIGN: We investigated 223 pregnant women with mild chronic hypertension and 200 controls. Twenty-four-hour BP monitoring longitudinally in pregnancy and Doppler assessment of uterine arteries at 24 weeks' gestation were performed. Perinatal outcomes were recorded. RESULTS: Superimposed preeclampsia occurred in 28.4% of hypertensive women, with an increased rate of small-for-gestational age babies (30.7% versus 8.9%), a lower birth weight (2587.75+/-832.97 versus 3167.35+/-536.3; p < 0.001) and a higher rate of caesarean sections (69.2% versus 35.5%) than controls. According to the ROC curve, the mean 24-h blood pressure (diastolic 78 mmHg [S.E.: 0.95; SP: 0.89] and systolic 121 mmHg [S.E.: 0.88; SP: 0.92]) and the mean resistance index of the uterine arteries of 0.52 (S.E.: 0.69; SP: 0.87) are better prognostic values for predicting superimposed preeclampsia. CONCLUSIONS: In women with chronic hypertension in the second trimester 24-h blood pressure monitoring and Doppler velocimetry of the uterine artery are able to detect those at risk of superimposed preeclampsia. In women with circulatory adaptation to pregnancy, a good perinatal outcome is expected with proper obstetric care.     

Pregnancy, labor and puerperium in patients with HELLP syndrome

OBJECTIVE: The aim of this study was to evaluate retrospectively 10 women with the syndrome of hemolysis, elevated liver enzymes, low platelets (HELLP)--age of patients, quality of antepartum medical care, clinical, biochemical parameters, treatment, course and duration of pregnancies, way of delivery, and puerperium. MATERIAL AND METHODS: Women in the study group were divided in order of platelets (PLT) levels: 4 patients with PLT levels lower than 50 G/l and 6 patients with PLT levels higher than 50 G/l. The mean duration of pregnancies in both groups was similar. RESULTS: In the first group just one women delivered by vaginal route when compared with the cesarean delivery. We noticed lower frequency of antepartum medical visits among the first group. Such signs as vomiting, nausea, abdominal pain, pruritus occurred more frequently in the second group. The most common complication observed in both groups of patients was severe preeclampsia. HELLP syndrome was also observed in the multiple pregnancies. In the study group high blood concentrations of urea, creatinine, total bilirubin, alanine transaminase and aspartate aminotransferase were present. Termination of pregnancy is still recognised to be the best way of HELLP treatment, however the efficacy of steroid drugs administration as conservative treatment were also demonstrated. CONCLUSION: The disseminated intravascular coagulation as the HELLP complication in the puerperium period seems to be a serious problem, which can conduct to the need of hysterectomy.     

The Impact of Parity on the Incidence of HELLP Syndrome and Small for Gestational Age Infants in Hypertensive Pregnant Women

Objectives: To determine whether maternal and fetal complications such as HELLP hemolysis, elevated liver enzymes, low platelets) syndrome and the incidence of small for gestational age infants in women with preeclampsia and gestational hypertension differ with both gravidity and parity.Study Design: The charts of 441 hypertensive women, 182 with preeclampsia and 259 with gestational hypertension, presenting for delivery at B.C. Women’s Hospital were retrospectively reviewed. Multiple clinical parameters, including gestational age at presentation the incidence of small for gestational age SGA infants, HELLP syndrome, and the severity of preeclampsia, were compared among three groups of women: (A) primigravid primiparous, (B) multigravid primiparous, and (C) multiparous. Mean values between the groups were compared using analysis of variance with pair-wise comparison using the Tukey test.Results: The incidence of HELLP syndrome among the women with preeclampsia was similar in groups A and B 35% and 50%, respectively), but significantly lower (p < 0.012) in group C (19%). The incidence of small for gestational age infants among the women with preeclampsia was similar for groups A, B, and C (27%, 31% and 19%) respectively). In the gestational hypertensive group the incidence of SGA infants was similar for groups A, B, and C (14%, 11%, and 12% respectively).Conclusions: The preeclamptic primigravid primiparous and multigravid primiparous groups behaved similarly in their clinical expression of hypertensive complications but differed from the multiparous group by having a higher incidence of HELLP syndrome. The incidence of complications in hypertensive pregnant women varied by parity but not by gravidity. The gestational hypertensive groups did not differ in their clinical expression of hypertensive complications.     

Maternal and fetal outcome of pregnancy complicated by HELLP syndrome

Objective.?The study evaluated the maternal and fetal outcome in 64 pregnancies complicated by HELLP syndrome.

Methods.?A retrospective analysis of the medical records was performed of patients with HELLP syndrome managed at this tertiary Obstetric unit between January 1996 and December 2005, who were admitted for preeclamsia/eclampsia and had documented evidence of hemolysis, elevated liver enzymes and low platelet count. Maternal and neonatal complications were recorded and analyzed.

Results.?The incidence of HELLP syndrome in the study was 8.3%. Mean gestational age at delivery was 32.4?±?4.2 weeks and mean birth weight was 1851?±?810?g. Forty-two percent of the patients had deliveries <32 weeks and 28% IUGR. Respiratory distress syndrome was the main indication for NICU admissions (33.9%). The PNM rate was 20%. Maternal morbidity rate was 34%. The most common maternal complications were abruptio placentae (36.4%) and DIC (31.8%). There was no maternal death.

Conclusion.?Once the diagnosis of HELLP syndrome is confirmed, the management depends on several obstetric and maternal variables like gestational age, severity of laboratory abnormalities and fetal status. As soon as the maternal condition is stabilized and fetal assessment is obtained, prompt delivery of the fetus is indicated. It is not yet established whether expectant management in preterm pregnancies with HELLP syndrome would improve perinatal outcome.     

Anesthesia in pregnant women with HELLP syndrome.

OBJECTIVE: Our purpose was to determine the types of anesthesia and neurologic or hematologic complications found in pregnancy with HELLP syndrome providing analgesia for cesarean section. METHODS: This is a retrospective study. For the period of 1 July 1996, through 30 June 2000, we reviewed the charts of all patients with HELLP syndrome who had cesarean section. RESULTS: During the period of study 119 patients had HELLP syndrome. Eighty-five patients had cesarean delivery and 34 had vaginal delivery. Seventy-one patients had diagnosed HELLP syndrome previous to the anesthesia and 14 postcesarean delivery; the range platelet count was 19000-143000/microl. Of these 71, 58 had an epidural anesthesia, 9 had general anesthesia and 4 had spinal anesthesia. There were no neurologic complications or bleeding in the epidural space. CONCLUSION: We found no documentation of any neurologic or hematologic complications of women with HELLP syndrome and neuraxial anesthesia.