The HELLP syndrome: maternal and perinatal outcome

The HELLP syndrome is a rare condition with a variable presentation, and in general, the outlook for mother and baby is felt to be poor. The aims of this study were to determine the maternal and perinatal outcome in cases of the HELLP syndrome at the Rotunda hospital over a five-year period. A retrospective review of all cases of confirmed HELLP syndrome from 1/1/95 to 1/9/99 was undertaken. Antenatal, intrapartum and neonatal data and in particular, maternal and neonatal complications were recorded. There were 20 cases of HELLP syndrome over the 5-year period. Mean maternal age was 29.8 (19-43) years. 70% were nulliparous. 80% delivered within 24 hours of diagnosis. 85% were delivered by caesarean section. Mean gestation at delivery was 33.5 (24-41) weeks, 65% of which were preterm. 70% of the babies were admitted to the neonatal intensive care unit (NICU). Mean birth weight was 1923g (440-4640g). Mean length of stay was 23.8 (1-68) days. 40% developed respiratory distress syndrome (RDS) with a mean duration of ventilation for these infants of 2.4 (0.5-7) days. There were 2 perinatal deaths both of whom weighed <500g. 95% of women were admitted to the High Dependency Unit. There were no maternal deaths. The mean interval to resolution of laboratory indices to within normal reference ranges was 11 (2-30) days. Maternal morbidity was high, but short-term, with full resolution in all cases. Once the diagnosis was made, delivery was immediate. The neonatal morbidity was also high and was most closely related to the gestation at delivery.