THE INTERRELATIONSHIP OF ECLAMPSIA, HELLP-SYNDROME, AND PREMATURITY -COFACTORS FOR SIGNIFICANT MATERNAL AND PERINATAL RISK

Objective To determine if there are differences between mothers and fe tuses in eclamptic pregnancies with or without concurrent HELLP syndro me. Design Retrospective review. Setting A single tertiary perinatal c entre, the University of Mississippi Medical Center. Subjects All ecla mptic pregnancies treated during a 141 month period from 1980 until th e end of 1991. Methods Pregnancies were grouped according to the prese nce or absence of HELLP syndrome subclassified as class 1 = platelet n adir less-than-or-equal-to 50 000/mul, class 2 = platelet nadir > 50 0 00 to less-than-or-equal-to 100 000/mul, and class 3 = platelet nadir >100 000 to less-than-or-equal-to 150 000/mul. Results Among 49 782 li ve births, there were 117 women with eclampsia prior to delivery (inci dence 1:425), 62 of which had HELLP syndrome. The group with HELLP syn drome were delivered significantly earlier (32.1 vs 36.4 weeks), and h ad lower birthweights (1821 vs 2550 grams) and higher perinatal mortal ity (113 vs 18:100). They were also transfused more frequently (65% vs 35%), and suffered greater overall serious maternal morbidity and mor tality. Conclusion Eclampsia is more likely to be associated with the HELLP syndrome at early gestations. Although eclamptic patients are al ready at risk, the presence of HELLP syndrome accentuates the risk for adverse maternal-perinatal outcome.