HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndromeversus severe preeclampsia: Onset at <= 28.0 weeks' gestation

OBJECTIVE: Our purpose was to determine whether the onset of the HELLP (hem olysis, elevated liver enzymes, and low platelet count) syndrome in women a t less than or equal to 28.0 weeks' gestation is associated with an increas ed risk of adverse maternal and perinatal outcomes in comparison with the r isk for women with severe preeclampsia but without the HELLP syndrome at a similar gestational age. STUDY DESIGN: Sixty-four patients with either the HELLP syndrome (n = 32) o r severe preeclampsia but absent HELLP syndrome laboratory test results (n = 32), admitted at less than or equal to 28.0 weeks' gestation between July 1, 1992, and April 30, 1999, were studied. Maternal and perinatal outcomes were compared between the 2 groups. Statistical analysis was performed by the Student t test and the Fisher exact test. RESULTS: There were no significant differences between the 2 groups regardi ng African-American race (59% vs 75%), nulliparity (50% vs 56%), or the use of corticosteroids (59% vs 78%). There were no maternal deaths. One woman with the HELLP syndrome had a liver hematoma. The rate at which transfusion of blood products was required was significantly greater in women with the HELLP syndrome than in those with severe preeclampsia only (25% vs 3%; P<. 05). There were no significant differences between the 2 groups with respec t to eclampsia (16% vs 13%), abruptio placentae (6% vs 9%), disseminated in travascular coagulopathy (13% vs 0%), pulmonary edema (13% vs 6%), acute re nal failure (3% vs 0%), pleural effusion (3% vs 3%), or ascites (6% vs 16%) . No significant differences were found between the 2 groups with respect t o neonatal death (11% vs 17%), respiratory distress syndrome (78% vs 86%), or composite neonatal morbidity. CONCLUSIONS: Except for the need for transfusion of blood products in women with the HELLP syndrome. onset at <less than or equal to>28.0 weeks' gesta tion is not associated with an increased risk of adverse maternal or neonat al outcomes in comparison with the risk for women with severe preeclampsia but without the HELLP syndrome at a similar gestational age.