Vnitr Lek 2010, 56(Suppl 1):98-103

The HELLP syndrome - its course and endothelial activation markers activity

O. Šimetka^1,*, J. Procházková², J. Gumulec³, I. Michalec¹, H. Zewdiová¹, R. Kolářová⁵, M. Procházka⁴

¹ Porodnicko-gynekologická klinika FN Ostrava, přednosta MUDr. Ondřej Šimetka

² Hemato-onkologická klinika Lékařské fakulty UP a NF Olomouc, přednosta prof. MUDr. Karel Indrák, DrSc.

³ Ústav klinické hematologie FN Ostrava, přednosta MUDr. Jaromír Gumulec

⁴ Porodnicko-gynekologická klinika Lékařské fakulty UP a FN Olomouc, přednosta doc. MUDr. Radovan Pilka, PhD.

⁵ Oddělení neonatologie FN Ostrava, prim. MUDr. Renáta Kolářová

Aims of the study:
Analysis of the course of pregnancy and its outcomes in patients with confirmed HELLP syndrome and comparison with published literature. An analysis of endothelial activation markers in patients with HELLP syndrome and their comparison with values found in physiological pregnancies.


Study design:
Prospective cohort study.


Study aim and methods:
We followed up 34 pregnancies complicated with the HELLP syndrome in women who gave birth at the Perinatology Centre Ostrava between 2004 and 2009. We performed analyses of endothelial activation markers using ELISA, immunoturbidimetry, ELISA with fluorogenic detection and flow cytometry and their levels were compared with values in the third trimester of physiological pregnancies.

Results:
Between 2004 and 2009 (64 months) 34 women gave birth at the Perinatology and Gynaecology Centre of the Faculty Hospital Ostrava who were diagnosed with laboratory-confirmed HELLP syndrome. The mean age of the researched women was 28.5 years, the mean gestational age at the time of pregnancy cessation was 33 weeks and 4 days. Only 2 women delivered spontaneously, 32 gave birth by caesarean section (CS), 54% of newborns were hypotrophic, 3 of these pregnancies were with twins. Deviations from laboratory norms in coagulation factors were identified in 22 patients, although clinical signs of a coagulation disorder were manifested in 8 patients (23.5%) only. A total of 6 patients were administered blood transfusion (18 units) and 9 patients were administered plasma (a total of 20 units). The mean duration of stay at the Intensive Care Unit was 3.2 days. None of the women died. One foetus was stillborn, postnatal period of 12 newborns (33.3%) was complicated with a serious morbidity. All pregnancies were terminated within 24 hours from the diagnosis. Of the endothelial activation markers, statistically significant deviations in the activity and levels of vWf antigen and in EPCR, MMP-2 and MMP-9 levels were observed. On the other hand, thrombomoduline, t-PA, PAI-1 and TIMP-2 levels were not statistically significantly higher in patients who developed HELLP syndrome compared to women with physiological gravidity.

Conclusion:
Early diagnosis and active management significantly contribute to prevention of severe forms of the HELLP syndrome. The HELLP syndrome is accompanied by statistically significant elevation in plasma levels of endothelial activation markers.

Keywords: HELLP syndrome; complication; morbidity; prediction; endothel

Received: April 27, 2010; Published: February 1, 2010  Show citation