The Spectrum of HELLP Syndrome A retrospective study of cases from 2005 - 2020

Abstract

Background: HELLP Syndrome is a pregnancy complication that was first identified almost four decades ago. Since then, researchers and clinicians continue to refine not only its definition, but also newer laboratory cut off values for diagnostic purposes. Unsurprisingly, HELLP syndrome continues to be one of the most unresolved challenges in the field of obstetrics. Aims: To examine the multifaceted nature of HELLP syndrome, with a special emphasis on its manifestation, classification, severity of morbidity, maternal outcome, and neonatal implications. Methodology: A retrospective single center study identified 163 patients diagnosed with HELLP syndrome between 2005 and 2020. A detailed statistical analysis of demographic, clinical, and laboratory parameters was conducted. The study population was divided into a subgroup based on the timing of occurrence of HELLP, pre- and postpartum (PRE and POST). The entire study population was then also divided into a separate subgroup based on the severity of morbidity (clinical manifestation and complication), SEVERE and LOW. Subgroups were compared using Mann- Whitney- U Tests and t-Test. The Chi-square test was used to determine the relationship between categorical variables. A p value of < .05 was defined as statistically significant. Results: Statistical analysis revealed that a HELLP syndrome leading to severe maternal morbidity (SEVERE group) correlates with low platelet counts (300 U/L), high LDH (>550 U/L), and high blood pressure (systolic >170 mmHg, diastolic >100 mmHg, or mean arterial pressure >120 mmHg). Applying the endpoints to the subgroups PRE and POST showed no statistically significant dissimilarity between the two across all categories (p > 0.05), except the laboratory values (p 0,05): age (31 years), BMI (23), gestational period (34 weeks), symptoms (upper abdominal pain, headache, nausea), and expected mode of delivery (caesarean section). Discussion: Despite the identification of significant markers for severe morbidity, paradoxically, some cases deviated from this pattern, showcasing the unpredictability and complexity inherent in this syndrome. Patients presenting with these markers must be closely monitored, and delivery should be induced or planned if the woman is still pregnant. Comparison of our results with seminal studies revealed parallels and variations in the onset, severity, and outcomes of HELLP syndrome across different populations. While consistent trends in symptomatology were observed, deviations in maternal age, delivery methods, and maternal mortality rates indicate the need for further research into potential influences on syndrome manifestation and severity. Conclusions and future directions: The presented data revealed statistically significant parameters for severe morbidity in HELLP Syndrome, that could potentially be used as predictive markers. In addition, the data offer insights into its pre- and postpartum manifestation, maternal outcomes, and neonatal implications. Especially the continued predominance of preterm deliveries in HELLP syndrome cases, highlight the persistent challenges in managing this condition. The need for further multi-centric studies incorporating diverse populations is warranted, especially due to the complexity of this syndrome, including the potentially fatal outcome of mother and child.

Datum der Bewilligung	2024
Originalsprache	Englisch
Gradverleihende Hochschule	Medizinische Universität Graz
Betreuer/-in	Nandu Goswami (Betreuer*in) & Ioana-Claudia Lakovschek (Mitbetreuer*in)