MANAGING THE DREADED HELLP SYNDROME; CONVERTING LOSSES TO NEAR MISSES
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 17
Abstract
BACKGROUND HELLP is a rare life-threatening obstetric syndrome. It is a multisystemic complication of preeclampsia occurring in 0.1 to 0.8% of all pregnancies and in 10% to 20% of those with severe preeclampsia/eclampsia. This dreaded condition was traditionally associated with high rates of perinatal mortality over 70% and maternal mortality over 25%. However recent trends in early recognition and diagnosis, effective assessment and the rapid initiation of medical and obstetric critical care, all offer significant improvement in maternal and foetal prognosis. Aims and Objectives- To analyse the incidence, maternal and neonatal outcome of HELLP syndrome in a tertiary care teaching hospital serving a semi urban and rural population and to study management solutions to reduce maternal and perinatal mortality. MATERIALS AND METHODS A retrospective descriptive study identified 20 cases of HELLP syndrome from a total of 4286 deliveries and 110 cases of severe preeclampsia (100 cases) and antepartum eclampsia (10 cases) over a one-year period. Important parameters assessed were predisposing factors, gestation at presentation, critical care, mode of delivery and maternal and perinatal outcomes. RESULTS The mean maternal age was 23.8 years with severe preeclampsia diagnosed in 17 and eclampsia in 3 cases. The syndrome manifested in 16 cases at a mean gestational age of 34.5 weeks and postnatally in 4 cases. The average platelet was 42000 with elevated liver enzymes in all and increased creatinine in 14 cases. An average of 5 units of FFPs and 3 units of platelets were infused. 8 women had vaginal deliveries and 12 had caesarean sections. There were 4 maternal deaths, 2 stillbirth and 4 neonatal deaths. CONCLUSION In spite of being a tertiary referral centre the potential maternal loss related to the HELLP syndrome was converted to a maternal near miss in a majority of cases. Identification, obstetric critical care management with adequate blood products, appropriate delivery and advanced neonatal care all worked to improve the final outcomes for the mother and her neonate, a truly satisfying result for the multispecialty clinical team.
Authors and Affiliations
Zubin Sheriar, Sanjaykumar Patil, Yamini Patil
Keywords
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- EP ID EP415188
- DOI 10.14260/jemds/2018/478
- Views 86
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