THE INTRAPARTUM PLATELET COUNT IN PATIENTS WITH HELLP (HEMOLYSIS, ELEVATED LIVER-ENZYMES, AND LOW PLATELETS) SYNDROME - IS IT PREDICTIVE OFLATER HEMORRHAGIC COMPLICATIONS

OBJECTIVE: We wished to determine in patients with HELLP syndrome (hem olysis, elevated liver enzymes, and low platelets) whether (1) there i s an intrapartum threshold platelet count that is predictive of immedi ate or delayed hemorrhagic complications and (2) whether prophylactic platelet transfusion at delivery prevents these outcomes. STUDY DESIGN : In this retrospective, descriptive study, the peripartal courses of 132 patients with class 1 (less than or equal to 50,000/mu l platelet nadir) and 160 patients with class 2 (> 50,000 but less than or equal to 100,000/mu l platelet nadir) HELLP syndrome were reviewed with spec ial attention to laboratory data, evidence of hemorrhage, and details of platelet transfusion therapy. RESULTS: A higher incidence of postpa rtum hemorrhagic complications (p < 0.001) occurred in class 1 versus class 2 HELLP pregnancies. The tendency to have postpartum incisional bleeding after abdominal or vaginal delivery was related to the degree of thrombocytopenia (p = 0.006). The antepartum threshold platelet co unt most predictive of subsequent postpartum hemorrhagic complications was less than or equal to 40,000/mu l. The prophylactic administratio n of platelets does not appear to have either significantly decreased the incidence of postpartum hemorrhagic complications or significantly hastened normalization of the postpartum platelet count. CONCLUSIONS: Although bleeding in the gravid patient is related to more factors th an platelet count alone, patients with HELLP syndrome in whom an intra partum platelet count above 40,000/mu l is maintained are unlikely to have clinically significant postpartum bleeding. Patients with intrapa rtum platelet counts less than or equal to 40,000/mu l, however, are a t significant risk for postpartum bleeding, but prophylactic platelet transfusion at delivery does not ensure a significantly lower incidenc e of postpartum hemorrhagic complications.