THE HELLP-SYNDROME - ITS ASSOCIATION WITH UNEXPLAINED ELEVATION OF MSAFP AND MSHCG IN THE 2ND-TRIMESTER

In this study, we examined the relationship between concentrations of maternal serum alpha-fetoprotein (MSAFP) and maternal serum human chor ionic gonadotropin (MShCG) in the second trimester and the 'haemolysis , elevated liver enzymes, low platelet count' (HELLP) syndrome. The co ncentrations of both serum markers, expressed in multiples of the medi an (MOM), in 16 women with the HELLP syndrome were compared with those in 10 443 women without this syndrome who were screened for Down's sy ndrome and neural tube defects. All the women with a singleton pregnan cy and a known pregnancy outcome were included in this study. At a cut -off level of 2.5 MOM, 37.5 per cent of the pregnancies with the HELLP syndrome had an elevated MShCG level, compared with 4.8 per cent in t he whole population (P<0.0001). 12.5 per cent of the women with the HE LLP syndrome had an elevated MSAFP level, compared with 1.3 per cent i n the whole population (P<0.025). Women with a combined elevation of M SAFP and MShCG levels (0.3 per cent of the screened population) had a 47 times greater risk of developing the HELLP syndrome than the others (P<0.01). The HELLP syndrome should be taken into account in the case of unexplained elevated levels of MShCG and MSAFP. especially in the rare event of combined elevation of both markers. (C) 1997 by John Wil ey & Sons, Ltd.