The importance of early diagnosis and immediate delivery in cases of HELLP-syndrome

Between 1.1.1988-31.7.1994 49 patients with HELLP-syndrome were treated at the Department of Gynaecology and Obstetrics, University Hospital, Cologne. 78% of the patients were primiparous with an incidence of 10.2% multiple pregnancies. Median gestational age at delivery was 35 weeks (range 23-41 weeks). In 20.4% of the cases HELLP-syndrome occurred in the postpartum period. 57% of the patients were complaining of right upper abdominal pain. Median time interval between diagnosis and delivery was 150 minutes resulting in a Caesarean section rate of 94%. Maternal mortality was 0, maternal complications occurred in 10.2 %; fetal loss rate was 12.7 % including 2 stillbirths, 1 lethal malformation and 4 extremely growth-retarded fetuses with birth weights between 375 g to 1080 g. There was no correlation between degree of thrombocytopenia and severity of preeclampsia but between degree of thrombocytopenia and extent of liver enzyme elevation. Based on our experience we recommend laboratory screening including measurements of liver enzymes, haptoglobin and platelet count in every patient complaining of upper abdominal pain, regardless of the severity of preeclampsia, and delivery without delay, preferably by Caesarean section, after the diagnosis of HELLP-syndrome has been made to improve maternal mortality and morbidity in this life-threatening condition.