A Study to Find the Incidence of HELLP Syndrome and Partial HELLP Syndrome among Preeclamptic Mothers and their Impact on Fetomaternal Outcome

BACKGROUND: Every woman wishes to have a healthy pregnancy which culminates in a healthy baby and a healthy mother. Unfortunately, some women develop dreaded complications that may result in adverse obstetric outcomes. These include Pregnancy induced hypertension, Pre-eclampsia, Eclampsia and HELLP Syndrome, abruption placenta, placenta previa, RH isoimmunisiation, etc. The HELLP syndrome (haemolysis, elevated liver enzymes, and low platelets) is a variant seen as a complication in severe preeclampsia / eclampsia that is associated with significant maternal and perinatal morbidity and mortality. HELLP is an acroynm coined by Weinstein in 1982. Maternal mortality is due to consequences such as pulmonary oedema, renal failure, disseminated intravascular coagulation and subcapsular liver hematoma. Perinatal mortality appears to be primarily related to the gestational age at the time of delivery. HELLP syndrome is regarded as a higher risk for the mother and neonate compared to pre-eclampsia. As our hospital provides treatment facilities to large number of Preeclampsia, eclampsia and a relatively higher number of patients of HELLP syndrome, we have the opportunity to conduct such studies which can help us to determine the trend of occurrence of HELLP syndrome, its complications and its effect on maternal and fetal outcome. This will help us in understanding better about the pathophysiology of the disease which can be applied to improve the management and thereby improve the maternal and perinatal outcome. AIM OF THE STUDY: 1. To detect and evaluate the feto-maternal outcome of HELLP syndrome and partial HELLP syndrome among preeclamptic mothers. 2. To determine the trend of occurrence of HELLP syndrome, risk factors, its complications and its effect on maternal and perinatal outcome of HELLP syndrome in pregnant women at Institute of Obstetrics and Gynaecology, Egmore, Chennai. MATERIALS AND METHODS: After institutional ethical committee approval and informed written consent, Analysis of 120subjects were selected from the study population which comprised of pre-eclamptic patients attending the outpatient department and those admitted in the antenatal ward as booked cases or referred from outside who appertaining the inclusion criteria during the year 2021 in IOG, Egmore, Madras Medical College Hospital, Chennai, to determine the occurrence and course of HELLP Syndrome in order to make a timely intervention and to render optimal patient treatment, a better maternal and perinatal outcome. History regarding age, parity, gestational age, menstrual history and previous illness were noted. A thorough general and other systemic examination, laboratory testing were done with obstetric examination. Every individual were allocated into one of the following groups: 1. Pregnant mothers with preeclampsia having the features of HELLP syndrome, which included both complete and partial HELLP syndrome. 2. Mothers with preeclampsia having only partial HELLP syndrome. 3. Mothers with preeclampsia without the features of complete HELLP syndrome or partial HELLP syndrome. Outcome will be measured in terms of age of the mother, parity, socioeconomic status, antenatal care status, duration of gestation BP and degree of proteinuria, mode of delivery(Labour Natural/Forceps/vacuum delivery/Assisted breech/LSCS, delivery interval, perintal outcome (a. Alive / Still born / IUD: b. Term / Preterm: c. Birth Wt; d. Apgar)and maternal outcome. Data obtained will be tabulated and analysed systematically. RESULTS: A total of 120 patients took part in this study which include population from both IOG and KGH, Triplicane. The mean (SD) age of the study population was 24.28 (5.24) years. The minimum and maximum ages were 17 and 39 years respectively with a range of 22 years. Among the study participants, 64 (53.3%) had severe pre-eclampsia, 19 (15.8%) had HELLP syndrome and the remaining 37 (30.8%) had partial HELLP syndrome. The mean (SD) age of non HELLP individuals was 22.84 (3.76) years and that of HELLP individuals was 25.91 (6.91) years. The mean age in HELLP group is significantly high when compared to the non HELLP group. There was no significant difference between parity and HELLP syndrome although the incidence of HELLP was higher among the multi para women. The mean (SD) age in weeks of non HELLP individuals was 35.92 (2.48) and that of HELLP individuals was 33.89 (2.87). The mean age in HELLP group is significantly lower when compared to the non HELLP group. The incidence of HELLP is higher among unbooked cases 9 (75%) when compared to booked cases of preganancy where the incidence of HELLP is 47 (43.5%). It was found that the clinical parameters like systolic blood pressure, diastolic blood pressure, spot PCR, 24 hour urinary protein and urinary dipstick protein were all significantly higher in the HELLP group when compared to the non HELLP group. The mean haemoglobin and platelet counts were significantly lower in HELLP group when compared to the non HELLP group. Also, LDH levels were found to be significantly elevated in HELLP group. Transfusion history is present significantly higher in those having HELLP. In patients with HELLP syndrome, the peripheral smear contains significantly higher number of abnormal cells. In the non HELLP group, among 64 patients, 36 (64.3%) did not present with any maternal complications and only 28 (43.8%) presented with maternal complications. But, in the HELLP group, among 56 patients only 20 (35.7%) did not have maternal complications and 36 (56.2%) had some form of maternal complications. The number of fetal deaths was found to be more in the HELLP group when compared to the non HELLP group and the difference between two groups is found to be statistically significant. The number of neonatal deaths was found to be more in the HELLP group when compared to the non HELLP group and the difference between two groups is found to be statistically significant. Also, there were significant differences in APGAR scores both at 1 minute and at 5 minutes between the two groups. CONCLUSION: Whether HELLP Syndrome TRIAD - liver dysfunction including elevated liver enzymes, haemolysis and thrombocytopenia occur as a distrint entity or a part of a spectrum of pregnancy complications, is still questionable. High maternal and perinatal morbidity and mortality associated with HELLP SYNDROME is alarming. Hence high concern to be given in its management. HELLP Syndrome is an emergency obstetric help. It needs careful and close monitoring to look for maternal and neonatal well being in an equal attention basis. Timely action to be taken regarding delivery regardless of gestational age. So a patient of HELLP SYNDROME to be promptly recognized, timely intervention to be done, and optimal treatment need to be given to decline and to prevent maternal morbidity and mortality