Diagnosis of HELLP syndrome. Where are we?

Abstract

Background and Goal of Study: HELLP syndrome is a severe and rapidly progressing condition which requires distinct diagnostic considerations. The goal of the study was to evaluate the means of diagnostic criteria applied for HELLP syndrome diagnosis and assess their impact on the maternal and neonatal outcomes. Materials and Methods: A retrospective observational cohort study was carried out using medical records of tertiary perinatology center with the diagnosis of HELLP syndrome from the period of time between 2005 and 2013. The patients who fit the HELLP syndrome diagnosis were grouped by Mississippi-Triple Class system. Means of diagnosis and treatment outcomes were analyzed within those groups. Results and Discussion: Among the 45 patients with HELLP syndrome included in the study, 58% (n=26) fit the HELLP syndrome criteria and 42% (n=19) had partial HELLP syndrome. Within the HELLP syndrome group 30,8% of patients fitted Class 1, 53,8% and 15,4% had Class 2 and Class 3 HELLP syndrome respectively. During the hospital stay in 34,6% (n=9) of cases the patients' condition worsened. In our study severe preeclampsia was present in 96,2% (n=25) of cases of HELLP syndrome and 100% (n=19) of cases of partial HELLP syndrome. However the level of blood pressure did not correlate with the severity of patients' condition (p=0,656, X2=18,835). The clinical presentation varied within all classes and the only objective mean of diagnosis and evaluation of progression of the syndrome were laboratory tests. The treatment was based on the Mississippi protocol: (1) magnesium sulfate, (2) blood pressure control and (3) intravenous dexamethasone. Delivery of the fetus is the only etiological treatment. Mean time from admission to delivery was 27,5 (±27,5) hours in the group with HELLP syndrome and 38,6 (±65) hours in the partial HELLP syndrome group. Due to active multidisciplinary management complications developed only in 2 cas