Factors contributing to adverse maternal outcomes in patients with HELLP syndrome.

Objective: To determine the prognostic factors for adverse maternal outcomes in women with complete HELLP syndrome.

Methods: A retrospective cohort study was carried out by searching the hospital data for the diagnosis of HELLP syndrome according to Tennessee classification from January 2007 to January 2014. Data included a total of 171 patients between January 2007 and January 2014. The data were collected from the hospital records including demographic data variables, presence of preeclampsia/chronic hypertension, gestational age at the time of diagnosis, and adverse maternal outcomes in terms of eclampsia, disseminated intravascular coagulopathy, acute renal failure (ARF), pulmonary edema, abruptio placentae placental abruption, pleural effusion, ascites, transfusion, and death were determined as adverse maternal outcomes. Independent prognostic factors for each complication with adverse maternal outcome were determined.

Results: A total of 171 patients between January 2007 and January 2014 were included in the study. Clinical and laboratory parameters of 171 patients were analyzed. Risk factors for adverse maternal outcomes were as follows; aspartate amino transferase (AST) > 316 U/L, alanine aminotransferase (ALT) > 217 U/L, total bilirubin >2.0 mg/dL, lactate dehydrogenase (LDH) > 1290 U/L, blood urea nitrogen (BUN) > 44 mg/dL, and low platelets (<50,000/mm). The risk of eclampsia increased 4.1 times and 3.4 times in the presence of LDH >1290 U/L and headache, respectively. Younger maternal age also increased the risk of eclampsia. Risk of ARF increased 15 times at the levels of bilirubin >2.0.

Conclusions: Younger age, headache, bilirubin >2.0 mg/dL, LDH >1290 U/L, and low platelets (<50,000/mm) were independent prognostic risk factors for predicting adverse maternal outcomes.