Symptoms of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome are similar between early-onset disease and disease later in gestation, according to a recent review published in the American Journal of Obstetrics & Gynecology.
Takeaways
- Symptoms of HELLP syndrome, including hemolysis, elevated liver enzymes, and low platelets, are similar whether the condition occurs early or later in gestation.
- HELLP syndrome is characterized by specific criteria, including lactate dehydrogenase levels, platelet count, and liver enzyme abnormalities.
- Approximately 0.5% to 0.9% of pregnancies are affected by HELLP syndrome, and it's often associated with preeclampsia with severe features.
- HELLP syndrome can lead to serious complications, with a maternal mortality rate of up to 24%, and early-onset cases are relatively rare.
- In early-onset HELLP syndrome, antiphospholipid syndrome workup is recommended, and pregnancy outcomes are often challenging, with many cases resulting in fetal loss or neonatal complications.
HELLP syndrome is defined as an additional criterion for preeclampsia with severe features. Criteria for HELLP syndrome include lactate dehydrogenase (LDH) of 600 IU/L or more, platelet count under 100×109/L, and aspartate transaminase and alanine transaminase elevated over twice the regular upper limit.
Of pregnancies, 0.5% to 0.9% are impacted by HELLP syndrome, and 10% to 20% are impacted by preeclampsia with severe features. Symptoms of HELLP syndrome include right upper quadrant pain, general malaise, hypertension, nausea, vomiting, and proteinuria.
A maternal mortality rate of up to 24% has been reported in patients with HELLP syndrome. Additionally, early-onset HELLP syndrome is rare, making little known about its presentation. Investigators conducted a systematic literature review to address this information gap.
Databases evaluated include PubMed, Ovid MEDLINE, Scopus, CINAHL Cochrane Library, and ClinicalTrials.gov. Literature from the databases’ inception until January 1, 2023, were eligible for inclusion. Unpublished studies, review articles, and abstracts were excluded from the analysis.
Search terms included “hemolysis, elevated liver enzymes, low platelets,” “hemolysis, elevated liver enzymes, low platelets syndrome,”“HELLP,” “HELLP syndrome,” “previable,” “periviable,” “pre-viable,” “peri-viable,”“first trimester,” “second trimester,” “<23 weeks,” “before 23 weeks,” “<23 weeks’ gestation,” and “before 23 weeks’ gestation.”
Literature search, study selection, and data extraction were completed by 2 reviewers independently. Data extracted included obstetrical and medical history, gestational age at symptom onset and diagnosis, laboratory workup, clinical presentation, and maternal and neonatal outcomes.
There were 46 studies included in the analysis, of which 41 were case reports and 5 were case series. Most had a moderate risk of bias, determined by criteria with domains including selection, ascertainment, causality, and reporting. Across the included studies, 55 patients with 58 total pregnancies met the inclusion criteria.
Participants were aged a mean 29.2±6.0 years, and 23 were primigravidas. Seven cases of chronic hypertension and 5 cases of preeclampsia or gestational hypertension were reported.
