Temporising management of severe pre‐eclampsia with and without the HELLP syndrome

Abstract

OBJECTIVE: To test the null hypothesis that the course and outcome of pregnancy in patients with severe pre-eclampsia receiving temporising haemodynamic treatment does not depend on the presence or absence of the syndrome of haemolysis, elevated liver enzymes, and a low platelet count (HELLP). DESIGN: A case-controlled study. SETTING: High risk obstetric unit, University Hospital Rotterdam-Dijkzigt, Rotterdam. SUBJECTS: One hundred and twenty-eight consecutive pre-eclamptic patients with HELLP, gestational age less than 34 weeks, matched for maternal and gestational age with 128 pre-eclamptic patients without HELLP. INTERVENTION: Both groups were treated with volume expansion and pharmacologic vasodilatation under invasive haemodynamic monitoring with the aim of prolonging gestation and enhancing fetal maturity. MAIN OUTCOME MEASURES: Maternal and perinatal outcome in patients with and without HELLP. RESULTS: Except for variables pertaining to HELLP, clinical and laboratory data and median prolongation of pregnancy did not differ between both groups. Complete reversal of HELLP occurred in 43% of patients. Perinatal mortality was 14.1% in HELLP patients and 14.8% in patients without HELLP. No maternal complications occurred. CONCLUSION: We cannot reject the null hypothesis. Our data do not support a general recommendation of prompt termination of pregnancy in HELLP. Temporising treatment may improve fetal and neonatal as well as maternal outcome.