Risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome

OBJECTIVE: This study was undertake to determine risk factors for adverse m aternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. STUDY DESIGN: Maternal medical records of pregnancies complicated by HELLP syndrome managed between July 1, 1992, and April 30, 1999, were reviewed. R isk factors evaluated included maternal age, parity race, previous preeclam psia, chronic hypertension, gestational age at diagnosis, mean arterial blo od pressure, nadir blood platelet count (<50,000 cells/mu L vs greater than or equal to 50,000 cells/mu L), and peak serum levels of aspartate aminotr ansferase and lactate dehydrogenase. Maternal outcome variables analyzed in cluded eclampsia, abruptio placentae, disseminated intravascular coagulopat hy, pulmonary edema, pleural effusion, ascites, acute renal failure, liver hematoma, need for transfusion of blood products, cesarean delivery, and de ath. Statistical analysis was performed with the Student t test, the chi(2) test, and logistic regression analysis. RESULTS: A total of 183 women with HELLP syndrome were studied. Eclampsia w as present in 6%, abruptio placentae was present in 10%, and disseminated i ntravascular coagulopathy was present in 8%. Forty-one women (22%) required transfusion of blood products. Incidence of eclampsia significantly decrea sed with increasing gestational age, from 16% at less than or equal to 28 w eeks' gestation to 3% at >32 weeks' gestation (P<.05) and was higher among African American patients than among white patients (12% vs 3%; P<.05). Log istic regression analysis showed an independent relationship between eclamp sia and race (P<.05). Incidence of abruptio placentae was higher among wome n with previous preeclampsia than among women without this clinical history (26% vs 5%; P<.05). Disseminated intravascular coagulopathy was significan tly associated with abruptio placentae (P<.0001) and acute renal failure (P <.0001). A nadir platelet count of <50,000/mu L, a peak serum aspartate ami notransferase level of >150 U/L, and a peak serum lactate dehydrogenase lev el of >1400 U/L were not independent risk factors for adverse outcome. CONCLUSIONS: Among women with HELLP syndrome, African American race is a ri sk factor for eclampsia. Both acute renal failure and abruptio placentae ar e associated with disseminated intravascular coagulopathy. Laboratory param eters of HELLP syndrome are not independent risk factors for adverse matern al outcome.