TEMPORISING MANAGEMENT OF SEVERE PREECLAMPSIA WITH AND WITHOUT THE HELLP-SYNDROME

Objective To test the null hypothesis that the course and outcome of p regnancy in patients with severe pre-eclampsia receiving temporising h aemodynamic treatment does not depend on the presence or absence of th e syndrome of haemolysis, elevated liver enzymes, and a low platelet c ount (HELLP). Design A case-controlled study. Setting High risk obstet ric unit, University Hospital Rotterdam-Dijkzigt, Rotterdam. Subjects One hundred and twenty-eight consecutive pre-eclamptic patients with H ELLP, gestational age less than 34 weeks, matched for maternal and ges tational age with 128 preeclamptic patients without HELLP. Interventio n Both groups were treated with volume expansion and pharmacologic vas odilatation under invasive haemodynamic monitoring with the aim of pro longing gestation and enhancing fetal maturity. Main outcome measures Maternal and perinatal outcome in patients with and without HELLP. Res ults Except for variables pertaining to HELLP, clinical and laboratory data and median prolongation of pregnancy did not differ between both groups. Complete reversal of HELLP occurred in 43% of patients. Perin atal mortality was 14.1% in HELLP patients and 14.8% in patients witho ut HELLP. No maternal complications occurred. Conclusion We cannot rej ect the null hypothesis. Our data do not support a general recommendat ion of prompt termination of pregnancy in HELLP. Temporising treatment may improve fetal and neonatal as well as maternal outcome.