The utility of umbilical artery Doppler investigation in women with the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome

OBJECTIVE: Our aim was to study the utility of umbilical artery Doppler velocimetry in the management of women with the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. STUDY DESIGN: Fetuses of women with the HELLP syndrome underwent ultrasonographic evaluation at initial presentation. An abnormal umbilical artery Doppler study was defined as a systolic/diastolic ratio >5.0. The systolic/diastolic ratios were correlated with outcome variables including laboratory findings, latency, mode of delivery, and birth weight. RESULTS: Fifty women were enrolled into the study. Eighteen of the fetuses (36%) had abnormal waveforms, with 8 fetuses demonstrating either absent or reversed end-diastolic umbilical artery blood flow. The mean umbilical artery systolic/diastolic ratio was significantly higher for fetuses with intrauterine growth restriction or who were small for gestational age than for those without these diagnoses (P =.001, for each). No correlation was observed between the systolic/diastolic ratio and the laboratory findings at admission, the degree of hypertension at admission, or the latency to delivery (all, P >.05). No woman with a fetus at a viable gestational age having abnormal Doppler waveforms had a successful vaginal delivery. CONCLUSION: Abnormal umbilical artery Doppler velocimetry is associated with a higher risk of fetal growth restriction and a high likelihood of cesarean delivery. These values were not correlated with the severity of maternal disease.