[Increasing incidence of HELLP syndrome. Diagnosis and treatment].

QUESTION

The HELLP Syndrome as a complication of severe preeclampsia is becoming more frequent; because of the high risk for mother and child the immediate diagnostic and consistent therapy is of great importance.

METHODS AND RESULTS

From 1989 to 1992 there were in the Frauenklinik Krefeld 17 out of 5413 deliveries with HELLP Syndrome (3.1/1000). The combination of symptoms were different: Clinical symptoms as upper abdominal pain were present in 76% (13/17), hypertension in 70% (11/17). Typical laboratory parameters as increased level of LDH were seen in 94% (16/17), elevated liver enzymes in 88% (15/17) and thrombocytopenia in 82% (14/17). It was, for the most part, primiparas from 32nd to 38th gestational week. All patients were delivered directly after diagnosis had been made by cesarean section. In one of the cases we was forced to carry out the hysterectomy because of unstoppable bleeding of placenta increta. Other complications did not occur, all the patients were released from hospital after the usual period of hospitalization without any further complaints. Regarding the children there was one case of infans mortuus, no fetus died peri- or postpartal. The complication rate was 25% (4/16). However all children were released after intensive pediatric treatment, the results of pediatric controls were all normal.

CONCLUSION

By means of early diagnosis and immediate delivery it is possible to reach a significant improvement of prognosis for mother and child, even in a disease as serious as HELLP Syndrome.