Pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): Subsequent pregnancy outcome and long-term prognosis

OBJECTIVE: Our purpose was to describe subsequent pregnancy outcome and long-term maternal prognosis in women with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) during the index pregnancy. STUDY DESIGN: This is a descriptive and analytic study of women with HELLP syndrome admitted to E.H. Crump Womenʹs Hospital between August 1977 and July 1992. HELLP syndrome was defined by previously published laboratory criteria. Only patients who were delivered> 2 years ago were included (median 4 years, range 2 to 14 years). Date on these patients were obtained from our obstetric clinics, local physicians, local health departments, and hospital records. RESULTS: Adequate follow-up data were available on 341 patients. One hundred fifty-two women subsequently became pregnant. One hundred thirty-nine normotensive women had 192 subsequent pregnancies. Complications included preeclampsia (19%), preterm delivery (21%), intrauterine growth restriction (12%), abruptio placentae (2%), perinatal death (4%), and HELLP syndrome (3%). Seven of the 113 women with at least 5 yearsʹ follow-up (6.2%) had chronic hypertension, and 98 received oral contraceptive pills without complications. Thirteen women with preexisting chronic hypertension had 20 subsequent pregnancies. These women had a higher rate of preeclampsia (75%), preterm delivery (80%), intrauterine growth restriction (45%), abruptio placentae (20%), and perinatal death (40%) but a low rate of recurrent HELLP syndrome (5%). CONCLUSIONS: Women with HELLP syndrome have an increased risk of obstetric complications in future pregnancies but a low risk for recurrent HELLP syndrome. Oral contraceptive pills should not be contraindicated in normotensive women.