PM.01 Management and Outcomes of HELLP Syndrome in the UK. (26th April 2013) - Fitzpatrick, KE
Abstract : Objective: To describe the current management and outcomes of HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome in the UK. Methods: A national descriptive study using the UK Obstetric Surveillance System, including all women diagnosed with HELLP syndrome between June 2011 and May 2012. Results: 109 women were identified with HELLP syndrome. 69 women (63%) were diagnosed with HELLP syndrome antenatally at a median gestation of 35 weeks (range 21–41). 54% (37/68) of antenatally diagnosed women had a planned management of immediate delivery and delivered a median of 3 h 37 min after diagnosis (range 53 min–21 h 26 min); 43% (29/68) had a planned management of delivery within 48 h and delivered a median of 11 h 40 min after diagnosis (range 1 h 28 min–74 h 43 min); only 2/68 had a planned attempt at expectant management, with one delivering 3 days and the other 12 days after diagnosis. Overall, 41% (45/109) of women received corticosteroids (only three for maternal indications, two of whom were diagnosed postpartum), 78% (84/108) received antihypertensive medication and 78% (85/109) were given magnesium sulphate. Severe morbidity was noted in 15% (16/109) of the women and one woman died (case fatality 0.9%, 95%CI 0.02–5.0%). Major complications were reported in 9% (10/108) of infants and there were two perinatal deaths (perinatal mortality rate 18 per 1, 000 total births, 95%CI 2–62). All cases associated with major maternal or perinatal complication occurred in women delivered within 48 h of diagnosis or in women diagnosed postpartum. Conclusions: HELLP syndrome is associated with severe maternal and perinatal morbidity. Expectant management is rarely used in the UK.