Risk factors, management, and outcomes of HELLP and ELLP syndromes
- Haemolysis, elevated liver enzymes, and low platelets (HELLP) and elevated liver enzymes, low platelets (ELLP) syndromes are serious but uncommon pregnancy complications. Several management questions remain to be addressed, including the timing of delivery in women developing HELLP/ELLP preterm.
- The aim of this study was to use UKOSS to conduct a national, case–control study of HELLP/ELLP to investigate risk factors, management and outcomes.
- Between June 2011 and May 2012, 129 women with HELLP and 81 women with ELLP were identified.
- Women with HELLP were more likely to be aged over 35 years, (aOR 1.9, 95% CI 1.1–3.1), nulliparous (aOR 4.2, 95% CI 2.5–7.0), have had a previous gestational hypertensive disorder (aOR 3.5, 95% CI 1.5–8.1), and have a multiple pregnancy (aOR 4.5, 95% CI 1.5–14.1) than control women.
- HELLP/ELLP syndrome was diagnosed antenatally in 138 women (66%); 51% had planned management of immediate delivery and 43% had delivery planned within 48 hours. Only seven women (5%) had planned expectant (conservative) management.
- Women with HELLP syndrome were more likely than women with ELLP syndrome to have a blood transfusion (46% vs. 21%, P < 0.001) and to have additional severe morbidity (13% versus 1%, P = 0.003).
- There were no significant differences in outcomes (blood transfusion, intensive care unit admission, additional severe maternal morbidity or major infant complications) between women with planned immediate delivery and those with planned delivery within 48 hours.
- This suggests that a short delay in delivery, of up to 48 hours, may be considered when monitoring is reassuring and there are good clinical reasons for a delay, such as to allow administration of corticosteroids for fetal lung maturation.
Thank you to all members who contributed information to this study.
Details of this and other UKOSS study results can be obtained from the UKOSS website http://www.npeu.ox.ac.uk/ukoss/completed-surveillance. If you would like a reprint of any UKOSS publications please contact email@example.com.