Risk Factors, Management, and Outcomes of Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome and Elevated Liver Enzymes, Low Platelets Syndrome

Fitzpatrick, Kathryn E. BA, MSc; Hinshaw, Kim MB BS, FRCOG; Kurinczuk, Jennifer J. MD, MSc; Knight, Marian MBChB, DPhil

Obstetrics & Gynecology:
doi: 10.1097/AOG.0000000000000140
Contents: Original Research
Abstract

OBJECTIVE: To describe the risk factors, management and outcomes of hemolysis, elevated liver enzymes, and low platelets (HELLP) and elevated liver enzymes, low platelets (ELLP) syndrome in the United Kingdom.

METHODS: A case–control study was conducted using the U.K. Obstetric Surveillance System between June 2011 and May 2012, including 129 women diagnosed with HELLP, 81 diagnosed with ELLP, and 476 control women.

RESULTS: Women with HELLP were more likely than those in the control group to be 35+ years old (33% compared with 22%, adjusted odds ratio [OR] 1.85, 95% confidence interval [CI] 1.12–3.06), nulliparous (67% compared with 43%, adjusted OR 4.16, 95% CI 2.48–6.98), have had a previous gestational hypertensive disorder (9% compared with 7%, adjusted OR 3.47, 95% CI 1.49–8.09), and have a multiple pregnancy (7% compared with 2%, adjusted OR 4.51, 95% CI 1.45–14.06). Women with ELLP were more likely than those in the control group to be nulliparous (79% compared with 43%, adjusted OR 8.35, 95% CI 3.88–17.95), and have had a previous gestational hypertensive disorder (7% compared with 7%, adjusted OR 4.66, 95% CI 1.37–15.89). Of the women diagnosed antenatally with HELLP or ELLP, 51% (71/138) had planned management of immediate delivery, 43% (60/138) had delivery planned within 48 hours, and 5% (7/138) had planned expectant (conservative) management. No differences were found between women who had delivery planned within 48 hours and those who had planned immediate delivery in terms of the proportion who received blood products (37% compared with 33%, P=.681); were admitted to the intensive care unit (57% compared with 61%, P=.652); experienced severe morbidity (10% compared with 4%, P=.300); or had a neonate with major complications (6% compared with 11%, P=.342).

CONCLUSION: A short delay in the delivery of women diagnosed antenatally with HELLP or ELLP syndrome may be considered. However, the rarity of the condition limits study power.

LEVEL OF EVIDENCE: II

In Brief

A short delay in delivery of women with the syndrome of elevated liver enzymes and low platelets, with or without hemolysis, may be considered.

Author Information

National Perinatal Epidemiology Unit, University of Oxford, Oxford, and Sunderland Royal Hospital, Sunderland, United Kingdom.

Corresponding author: Kathryn E. Fitzpatrick, BA, MSc, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, UK; e-mail: kate.fitzpatrick@npeu.ox.ac.uk.

This article presents independent research funded by the National Institute for Health Research (NIHR) under the “Beyond maternal death: Improving the quality of maternity care through national studies of ‘near-miss’ maternal morbidity” program (Programme Grant RP-PG-0608-10038). Marian Knight is funded by a NIHR Professorship. The views expressed in this publication are those of the author(s) and not necessarily those of the National Health Service, the NIHR, or the Department of Health. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The authors thank the United Kingdom Obstetric Surveillance System reporting clinicians who notified cases and completed data collection forms.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.