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.