OBSTETRIC MANAGEMENT IN PATIENTS WITH HELLP-SYNDROME

The syndrome of haemolysis, elevated liver enzymes and low platelet co unt (HELLP-Syndrome) is a severe form of preeclampsia and eclampsia. T he clinical course is characterized by right upper quadrant and epigas tric pain, hypertension, proteinuria and edema. Maternal and neonatal morbidity are high. The underlying cause for this pregnancy-related sy ndrom is still unclear. As soon as a reliable diagnosis is established handling of patients suffering from HELLP-Syndrome is ambivalent: Imm ediate termination of pregnancy, however, poses a problem at early ges tational age. Therefore some authors have advocated a conservative man agement. At our department active management and delivery by Caesarian section as soon as possible has gained acceptance in the past 5 years . We report our experience with 23 patients over a 12 year period, and with 4 patients from the intensive care unit (N = 27). Mean gestation al age was 33.5 weeks (+/-4.8) and the mean birthweight was 1922.5 g ( +/- 971.5). 19 patients were delivered by Caesarian section. Most comp lications were based on a delayed delivery and subsequent deterioratio n of maternal condition. Reduction of the time interval between establ ishment of diagnosis and termination of pregnancy (1980-1985 - 3 days; 1986-1992 - 12 hours) resulted in a better outcome. We recommend inte nsive laboratory screening and exact clinical examination since missed or delayed diagnosis as well as delayed delivery are life threatening for mother and child. Only prompt delivery yields an improvement of p rognosis.