Maternal and fetal outcome
The most feared, but fortunately rare, complications of HELLP are liver subcapsular hematoma and rupture with shock. Other maternal complications include aggravation of thrombocytopenia with coagulation disorders or disseminated intravascular coagulation (DIC). Depending on definition, DIC occurs in up to 21 per cent of cases, but seems mainly related to the presence of abruptio placentae which represents the second most common complication (Table,1). Acute renal failure, congestive heart failure, and pulmonary edema are frequent and occur more often with postpartum onset. Severe ascites occurs in up to 10 per cent and correlates with the development of pleural effusions and pulmonary edema (Sibai.ef.a/ 1993). Intra-abdominal hematoma or uterine bleeding are observed in the postpartum period following Cesarean section (Vis.seLa.OdWaJlenbMrg 19.9.5.). Neurological complications can be expected when HELLP is associated with eclampsia. Maternal mortality is approximately 1 per cent in a tertiary care center but as high as 24 per cent in other centers ( SibaLeiJ,/ 1993).
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Table 1 Complications of the HELLP syndrome