The HELLP Syndrome: Clinical Issues and Complications. Management and Two Different Profilatic Considerations and Treatments: Heparin vs Dexamethason: A Review

Background HELLP, a syndrome characterized by Hemolysis, Elevated Liver enzyme levels and a Low Platelet count, is an obstetric complication that is frequently misdiagnosed at initial presentation. Many investigators consider the syndrome to be a variant of preeclampsia, but it may be a separate entity. The pathogenesis of HELLP syndrome remains unclear. Early diagnosis is critical because the morbidity and mortality rates associated with the syndrome have been reported to be as high as 25 percent. Its incidence is reported as 0.2-0.6% of all pregnancies. Of women with preeclampsia, 4-12% also develop signs of a superimposed HELLP syndrome, mortality is 7-35% and perinatal mortality of the child may be up to 40%. . Though delivery is the ultimate therapeutic option, medical treatments, including the use of heparin or corticosteroids, have been employed in the attempt to improve maternal prognosis. OBJECTIVE: The aim of this retrospective study during 2004-2013, in our hospital, was to detect incidence and the risk factors and to compare the time course of recovery and the incidence of complications in women with HELLP syndrome receiving either heparin or dexamethasone. METHODS:. Between January 2004 and December 2013, 32 patients with HELLP syndrome were cared for at the Institute of Obstetrics and Gynecology of the University of Tirana: 20 patients were treated with heparin, administered subcutaneously at a dose of 5000 IU every 12 h, whereas 12 women received dexamethasone, administered intravenously at a dose of 10 mg every 12 h. Categorical data were evaluated with chi-square and Fisher's exact test; continuous data were analyzed with Mann? Whitney U test; P less than 0.05 was considered significant. In the subgroup treated with heparin the incidence of disseminated intravascular coagulation (DIC) (P less than 0.02), the number of patients requiring blood transfusion (P less than 0.05) and the length of stay at the Intensive Care Unit (ICU) (P less than 0.04) were significantly increased as compared with the subgroup receiving dexamethasone; in this latter subgroup, significantly higher platelet count and hematocrit values, and significantly lower levels of lactate dehydrogenase (LDH) could be documented starting from day 2 after delivery. RESULTS: About 70% of the cases develop before delivery, the majority between the 28th and 37th gestational weeks; the remainder within 48 hours after delivery. The syndrome is a progressive condition and serious complications are frequent. Conservative treatment (? 48 hours) is controversial but may be considered in selected cases less than 34 weeks' gestation. Delivery is indicated if the HELLP syndrome occurs after the 34th gestational week or the foetal and/or maternal conditions. The results of our investigation suggest that the use of dexamethasone in patients with HELLP syndrome is associated with faster regression and lower incidence of complicationsm in comparison to heparin.