FACTORS RELEVANT TO MODE OF PRETERM DELIVERY WITH SYNDROME OF HELLP (HEMOLYSIS, ELEVATED LIVER-ENZYMES, AND LOW PLATELETS)

OBJECTIVE: Our purpose was to investigate factors relevant to mode of delivery for patients with preterm (< 34 weeks) gestation complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelet s (HELLP). STUDY DESIGN: The pregnancies of 189 patients with HELLP sy ndrome and delivery < 34 weeks' gestation between January 1980 and Oct ober 1991 were studied retrospectively. Only patients with class 1 (pl atelet nadir less than or equal to 50,000 per microliter, n = 83) and class 2 (platelet nadir > 50,000 to less than or equal to 100,000 per microliter, n = 106) HELLP syndrome were included. Maternal and perina tal factors relevant to type of delivery were reviewed. RESULTS: The i ncidence of cesarean delivery for all patients was 76.2% (primary rate 72.4%). Abdominal delivery occurred equally between class 1 (78.3%) a nd class 2 (74.5%) patients. Cesarean section was the mode of delivery for 87% of pregnancies at < 30 weeks' gestation in contrast to 68% of pregnancies at greater than or equal to 30 weeks but < 34 weeks' gest ation (odds ratio 3.2, 95% confidence interval 1.4 to 7.5, p < 0.005). Indications for cesarean section included deteriorating maternal cond ition alone (50%), deteriorating maternal and fetal condition (27%), n onvertex fetal presentation (11.5%), and failure to progress (11%). In duction of labor was significantly more successful during the greater than or equal to 30 but < 34 weeks' pregnancy interval (47.5%) than in pregnancies at < 30 weeks (15.2%) (odds ratio 0.2, 95% confidence int erval 0.1 to 0.55, p < 0.001). A trial of labor was successful in 22% of patients with an initial modified Bishop score less than or equal t o 2 versus 45% with an initial Bishop > 2 (odds ratio 0.5, 95% confide nce interval 0.2 to 1.3, p = 0.16). CONCLUSION: Parturients with class 1 and 2 HELLP syndrome at < 34 weeks' gestation are at high risk for cesarean delivery. At a gestational age < 30 weeks, the likelihood of successful labor induction with vaginal delivery is remote, especially in association with an unfavorable cervix or the absence of labor.