Maternal mortality associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome

OBJECTIVE: The aim of this study was to determine factors contributing to d eaths among women with HELLP (hemolysis, elevated liver enzymes, and low pl atelets) syndrome. STUDY DESIGN: Information from multiple sources was scrutinized to distingu ish and profile maternal deaths associated with HELLP syndrome. RESULTS: information was available regarding 54 maternal deaths. According to HELLP syndrome classification 60.0% had class 1 disease, 35.6% had class 2 disease, and 4.4% had class 3 disease. Events associated with maternal d eaths included cerebral hemorrhage (45%), cardiopulmonary arrest (40%), dis seminated intravascular coagulopathy (39%), adult respiratory distress synd rome (28%), renal failure (28%), sepsis (23%), hepatic hemorrhage (20%), an d hypoxic ischemic encephalopathy (16%). Delay in diagnosis of HELLP syndro me was implicated in 22 of 43 patients' deaths (51.1%). CONCLUSIONS: It appears that (1) most maternal deaths occurred among women with class 1 HELLP syndrome, (2) delay in diagnosis was associated with mor tal consequences, and (3) hemorrhage in the hepatic or central nervous syst em or vascular insult to the cardiopulmonary or renal system were associate d with increased mortality risk.