HELLP-SYNDROME - A FREQUENT - OBSTETRICAL EMERGENCY

Preeclampsia is a multisystem disorder of pregnancy whose clinical pre sentation is related to the importance and the extent of maternal micr o-vasculature damage. 16 patients with preeclampsia, thrombocytopenia (< 100 000/mm3), elevated liver enzymes and hemolysis are described. W einstein in 1982 assigned the acronyme of Hellp syndrom for this clini cal presentation of preeclampsia. This syndrome was fewly recognized d uring the first years of the study but was diagnosed later on, in 1 pr egnancy out of 600 parturitions and in 5 % of preeclampsia in 1991. Tw o out of the patients developed eclamptic seizures. The mode of delive ry was as follows : 9 out of 16 had an emergency Caesasean section; th e 7 other patients had vaginal delivery after induction of labor. Deli very occurred before 32 weeks of gestation for 6 out of 17 newborns. O utcome was good for 14 of the 17 newborns (one twin pregnancy). Two fe tuses died : one in utero and one during interruption of the pregnancy at 24 weeks of gestation. A small for gestational age preterm of 32 w eeks died on his second day of life. Early diagnosis of Hellp Syndrome , especially when abdominal pains are present, allows a prompt managem ent of these patients, including delivery, which appeared in our exper ience, the only way to avoid fetomaternal complications. The thromboti c microangiopathics and acute fatty liver of pregnancy are potential i mitations of Hellp syndrome and they must be considered for differenti al diagnosis. The frequency of Hellp Syndrome varies from one study to another. It can be increased up to 6 fold if referred to the number o f pregnancies and up to 3 fold if referred to the number of preeclamps ias. These differences can be real but may be due to bias related to d ifferences in practice between centers and also differences in definit ions of Hellp Syndrome and preeclampsia.