Maternal and fetal parameters including umbilical artery PI and fibrinogen/CRP ratio as predictive factors of perinatal outcome in women with HELLP syndrome

Abstract

Introduction: HELLP syndrome appears in approximately 0.2-1% of all pregnancies and is associated with increased maternal and fetal mortality and morbidity. It is diagnosed in cases when all three of the following criteria are present: 1) microangiopathic hemolytic anemia with abnormal blood smear, low serum haptoglobin and elevated LDH levels; 2) elevated ASPAT and ALAT (levels of both enzymes more than twice the upper limit of normal values), or bilirubin more than 1.2 mg/dl; 3) platelet count below 150x1009 L-1. The etiopathogenesis of HELLP syndrome is associated with abnormal placentation in the first trimester, production of cellular active substances, and pathological response of the maternal organism. Objectives: The aim of the study was to establish maternal and fetal characteristics and perinatal outcome in HELLP syndrome. The examination protocol included comparison of maternal blood parameters, umbilical artery pulsatility index (UmbA PI) in relation to short-term neonatal outcomes. Material and methods: Retrospective data analysis of patients hospitalized at the Perinatology and Gynecology Department, Polish Mother’s Memorial Hospital Research Institute between 2009-2013, due to HELLP syndrome was conducted. Results: None of the investigated maternal or fetal parameters correlated with the neonatal outcome. Conclusions: Our study demonstrated that maternal parameters do not influence the perinatal outcome in women with HELLP syndrome. Moreover, UmbA PI and fibrinogen/CRP ratio do not correspond to neonatal parameters, either. Thus, none of the examined features can be used as a prognostic factor of the neonatal outcome. Further studies with large sample size are necessary but the rarity of this complication limits the possibility of research.