Comparison of Clinical Features and Pregnancy Outcomes in Early- and Late-onset Preeclampsia with HELLP Syndrome: a 10-year Retrospective Study from a Tertiary Hospital and Referral Center in China

Overview

Journal BMC Pregnancy Childbirth

Publisher Biomed Central

Specialty Gynecology & Obstetrics

Date 2022 Mar 9

PMID 35260082

Authors

Boya Li

Huixia Yang

Affiliations

Soon will be listed here.

Abstract

Background: Early-onset preeclampsia (EO-PE) and late-onset preeclampsia (LO-PE) are different subtypes of preeclampsia. We conducted this study to analyze the similarities and differences in the clinical features and pregnancy outcomes in EO- and LO-PE with HELLP syndrome.

Methods: This was a retrospective study in a tertiary hospital. Eighty-three parturients with HELLP syndrome were allocated into two groups based on the timing of preeclampsia onset: EO-PE with HELLP (n = 47) and LO-PE with HELLP (n = 36).

Results: In total, 31.9% and 63.9% of women in the EO-PE with HELLP and LO-PE with HELLP groups, respectively, were asymptomatic at diagnosis (P = 0.004, OR = 0.265 (0.106-0.662)). Headache or visual symptoms were more frequent in the EO-PE group than in the LO-PE group (48.9% vs. 25%, P = 0.026, OR = 0.348 (0.135-0.896)). Women in the EO-PE with HELLP group had higher SBP and DBP than those in the LO-PE with HELLP group. Laboratory tests, including platelets, liver function, and hemolysis, which are the main indicators for the diagnosis of HELLP syndrome, showed almost no significant differences between the two groups, with kidney function being the only difference observed. Women in the EO-PE with HELLP group had higher Scr than those in the LO-PE with HELLP group. The degree of proteinuria was higher in the EO-PE group than in the LO-PE with HELLP group. The incidence of severe maternal complications was significantly higher in the EO-PE group than in the LO-PE with HELLP group (25.5% vs. 5.6%, P = 0.016, OR = 0.172 (0.036-0.824)). In total, 57.4% and 8.3% of neonates in the EO-PE and LO-PE with HELLP groups were admitted to the NICU, and the difference was statistically significant, even after adjustment for the delivery week (P = 0.009, OR = 0.830 (0.729-0.944)). Postpartum HELLP syndrome was more common in the LO-PE group than in the EO-PE group (30.6% vs. 4.3%, P = 0.001, OR = 9.9 (2.031-48.256)).

Conclusions: Compared with LO-PE with HELLP patients, EO-PE with HELLP patients have more obvious kidney damage, higher blood pressure and a higher risk of adverse maternal and neonatal outcomes. Patients with LO-PE need to be alerted to the occurrence of HELLP syndrome after delivery.

Citing Articles

Gestational Age at Delivery Is an Independent Predictor of Neonatal Outcome for Maternal HELLP Syndrome.

Shi Y, Yang X, Wang C, Zhuoga L, Xu D J Clin Hypertens (Greenwich). 2025; 27(1):e70007.

PMID: 39878396 PMC: 11775914. DOI: 10.1111/jch.70007.

The Role of Hypertension for Maternal Outcomes of Women with HELLP Syndrome - a Retrospective Study from a Tertiary Obstetric Center.

Muller L, Eveslage M, Koster H, Willy K, Mollers M, Schmitz R Geburtshilfe Frauenheilkd. 2024; 84(7):635-645.

PMID: 38993801 PMC: 11233203. DOI: 10.1055/a-2308-9698.

Prediction of HELLP Syndrome Severity Using Machine Learning Algorithms-Results from a Retrospective Study.

Melinte-Popescu M, Vasilache I, Socolov D, Melinte-Popescu A Diagnostics (Basel). 2023; 13(2).

PMID: 36673097 PMC: 9858219. DOI: 10.3390/diagnostics13020287.

Development and evaluation of a nomogram for adverse outcomes of preeclampsia in Chinese pregnant women.

Zheng J, Zhang L, Zhou Y, Xu L, Zhang Z, Luo Y BMC Pregnancy Childbirth. 2022; 22(1):504.

PMID: 35725446 PMC: 9210655. DOI: 10.1186/s12884-022-04820-x.

References

Mol B, Roberts C, Thangaratinam S, Magee L, de Groot C, Hofmeyr G . Pre-eclampsia. Lancet. 2015; 387(10022):999-1011. DOI: 10.1016/S0140-6736(15)00070-7. View

Malmstrom O, Morken N . HELLP syndrome, risk factors in first and second pregnancy: a population-based cohort study. Acta Obstet Gynecol Scand. 2018; 97(6):709-716. DOI: 10.1111/aogs.13322. View

Kornacki J, Boron D, Gutaj P, Mantaj U, Wirstlein P, Wender-Ozegowska E . Diagnosis of preeclampsia in women with diabetic kidney disease. Hypertens Pregnancy. 2021; 40(4):322-329. DOI: 10.1080/10641955.2021.1987454. View

. [Diagnosis and treatment guideline of hypertensive disorders in pregnancy (2015)]. Zhonghua Fu Chan Ke Za Zhi. 2015; 50(10):721-8. View

Kornacki J, Wirstlein P, Wender-Ozegowska E . Serum levels of soluble FMS-like tyrosine kinase 1 and endothelial glycocalyx components in early- and late-onset preeclampsia. J Matern Fetal Neonatal Med. 2021; 35(25):7466-7470. DOI: 10.1080/14767058.2021.1949704. View

Sibai B . Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 2004; 103(5 Pt 1):981-91. DOI: 10.1097/01.AOG.0000126245.35811.2a. View

Buck Louis G, Grewal J, Albert P, Sciscione A, Wing D, Grobman W . Racial/ethnic standards for fetal growth: the NICHD Fetal Growth Studies. Am J Obstet Gynecol. 2015; 213(4):449.e1-449.e41. PMC: 4584427. DOI: 10.1016/j.ajog.2015.08.032. View

Zhang J . Partner change, birth interval and risk of pre-eclampsia: a paradoxical triangle. Paediatr Perinat Epidemiol. 2007; 21 Suppl 1:31-5. DOI: 10.1111/j.1365-3016.2007.00835.x. View

Yildirim G, Gungorduk K, Gul A, Asicioglu O, Sudolmus S, Celikkol Gungorduk O . HELLP syndrome: 8 years of experience from a tertiary referral center in western Turkey. Hypertens Pregnancy. 2010; 31(3):316-26. DOI: 10.3109/10641955.2010.507849. View

10.

Hung T, Hsieh T, Chen S . Risk of abnormal fetal growth in women with early- and late-onset preeclampsia. Pregnancy Hypertens. 2017; 12:201-206. DOI: 10.1016/j.preghy.2017.09.003. View

11.

Dusse L, Alpoim P, Silva J, Rios D, Brandao A, Cabral A . Revisiting HELLP syndrome. Clin Chim Acta. 2015; 451(Pt B):117-20. DOI: 10.1016/j.cca.2015.10.024. View

12.

Erkilinc S, Eyi E . Factors contributing to adverse maternal outcomes in patients with HELLP syndrome. J Matern Fetal Neonatal Med. 2017; 31(21):2870-2876. DOI: 10.1080/14767058.2017.1359528. View

13.

Lisonkova S, Joseph K . Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease. Am J Obstet Gynecol. 2013; 209(6):544.e1-544.e12. DOI: 10.1016/j.ajog.2013.08.019. View

14.

von Dadelszen P, Magee L, Roberts J . Subclassification of preeclampsia. Hypertens Pregnancy. 2003; 22(2):143-8. DOI: 10.1081/PRG-120021060. View

15.

Audibert F, FRIEDMAN S, Frangieh A, Sibai B . Clinical utility of strict diagnostic criteria for the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Am J Obstet Gynecol. 1996; 175(2):460-4. DOI: 10.1016/s0002-9378(96)70162-x. View

16.

Li X, Guo P, Xue Y, Gou W, Tong M, Chen Q . An analysis of the differences between early and late preeclampsia with severe hypertension. Pregnancy Hypertens. 2016; 6(1):47-52. DOI: 10.1016/j.preghy.2015.12.003. View

17.

Saleem S, McClure E, Goudar S, Patel A, Esamai F, Garces A . A prospective study of maternal, fetal and neonatal deaths in low- and middle-income countries. Bull World Health Organ. 2014; 92(8):605-12. PMC: 4147405. DOI: 10.2471/BLT.13.127464. View

18.

Sibai B . The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): much ado about nothing?. Am J Obstet Gynecol. 1990; 162(2):311-6. DOI: 10.1016/0002-9378(90)90376-i. View

19.

Sibai B, Ramadan M, Usta I, Salama M, Mercer B, FRIEDMAN S . Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol. 1993; 169(4):1000-6. DOI: 10.1016/0002-9378(93)90043-i. View

20.

WEINSTEIN L . Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol. 1982; 142(2):159-67. DOI: 10.1016/s0002-9378(16)32330-4. View