MANAGEMENT OF HELLP-SYNDROME OCCURRING BE FORE 32 WEEKS GESTATION - ASERIES OF 22 CASES

Objectives: Assess expression and management of HELLP syndrome (hemoly sis, elevated liver enzymes, low platelet count) occurring before 32 w eeks gestation. Methods: Among 50 patients presenting HELLP syndrome f rom 1990 to 1994, 22 (44%) who developed the syndrome before 32 weeks gestation were evaluated retrospectively. Results: Most of the patient s were primiparous and HELLP syndrome recurred in 2 during a second ge station before 32 weeks gestation, Only three cases began during the p ost partum period, All patients had severe pre-eclampsia before discov ery of the HELLP syndrome, Episodes of eclampsia also occurred in 6. T he most frequent clinical manifestation was epigastric pain. Ten patie nts had acute severe renal failure, The 3 post partum patients had sev ere complications (eclampsia, renal failure, subcapsular hepatic hemat oma). Obstetrical intervention was required in all cases. Cesarean sec tion was performed within 48 hours of diagnosis, Pregnancy had to be t erminated in 3 cases between 24 and 29 weeks gestation. There was one fetal death in utero and one during the neonatal period. Seventeen liv e infants were delivered. In the group of 11 infants born after 30 wee ks gestation, only 1 had hyalin membrane disease which developed in al l those born before 30 weeks, including 2 with broncho-pulmonary dyspl asia. Conclusion: Based on the physiological mechanisms involved in HE LLP syndrome, criteria for obstetrical extraction and the possibilitie s for conservative management in very premature pregnancies, we propos e a management protocol for HELLP syndrome developing before 32 weeks gestation. Corticosteroid therapy may be given for 48 hours in cases w ithout maternal or fetal complications in order to accelerate fetal ma turation before extraction.