[HELLP syndrome: nine cases treated at Josephine-Bongo Maternity Hospital].

Abstract

Introduction: the aim of this study was to evaluate the management of HELLP syndrome at Josephine-Bongo Maternity Hospital.

Study population and methods: the retrospective study included all women admitted to the intensive care unit of our hospital from 1 January 2004 through 30 December 2007 with HELLP syndrome. The characteristics studied included: age, parity, number of previous pregnancies, antenatal monitoring, term at onset, clinical and laboratory signs, treatment, complications, perinatal and neonatal mortality and duration of intensive care unit admission.

Results: nine patients, mainly primiparas with an average age of 29.7 ± 6.5 years were admitted to intensive care. HELLP syndrome was diagnosed at a mean term of 33 ± 2.7 weeks. The clinical signs noted included the following: jaundice (100%), headaches (100%) and epigastric pain (67%). The laboratory analysis showed: a mean haemoglobin level of 8.7 ± 1.2 g/dL, an average platelet level of 70,900 ± 27,052.9/mm(3), and mean transaminase levels of 120 ± 60 UI/L for aspartate aminotransferase (AST) and 99 ± 41.1 UI/L for alanine aminotransferase (ALT). Hypertension was treated by continuous intravenous administration of nicardipine. The fetal pulmonary development was ensured with betamethasone. Delivery was by caesarean for four women (44%) and vaginal for the other five (56%). One maternal death was noted, related to a rupture of a subcapsular haematoma of liver.

Conclusion: in view of the extent of perinatal morbidity and mortality associated with HELLP syndrome, abdominal ultrasonography to detect any subcapsular haematoma of liver should be performed to determine the need for immediate delivery. It would be appropriate to provide the Josephine-Bongo Maternity Hospital with a neonatal intensive care unit of high quality.