Retrospective Analysis of Maternal and Neonatal Outcomes in Pregnant Women with HELLP Syndrome Under General and Spinal Anesthesia

Year 2022, Volume: 4 Issue: 3, 136 - 142, 31.12.2022

Berrin Günaydın , İrfan Güngör , Damlasu Selcen Muratoğlu , Beyza Mehri Büyükgebiz , Nuray Bozkurt

Abstract

We aimed to document anesthetic techniques for cesarean section in cases of HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome. A retrospective study was carried out in a tertiary center including all patients who underwent emergency cesarean section for HELLP syndrome. The immediate preoperative maternal laboratory results including complete blood count, D-dimer, ALT, AST, LDH, bilirubin, and uric acid), the method of anesthesia, and complications were recorded. Fetal and neonatal outcomes were reviewed. HELLP class of the patients according to Mississippi classification were made to compare demographics, laboratory results and perinatal outcomes.
A total number of 193 charts were reviewed and 25 ASA IV HELLP syndrome was identified and 22 of these parturients underwent cesarean delivery while the remaining 3 parturients had vaginal delivery. The mean maternal age and gestational age of all patients were 31.2±2.77 weeks and 32.08±3.95, respectively. General anesthesia was selected in 14 out of 22 patients (63.63%), while 8 out of 22 (36.36%) received single-shot spinal anesthesia. Preoperative platelet count was significantly higher (p<0.01) in the spinal anesthesia group. All patients with a lower platelet count than 50,000/µL received general anesthesia. Regarding the classification of parturients, there were 5, 7 and 10 patients in HELLP Class 1, 2 and 3, respectively. In conclusion although spinal anesthesia was used in selected HELLP patients in the literature, our data demonstrated that general anesthesia was the most commonly performed technique than spinal anesthesia in parturients with HELLP syndrome.

Keywords

Anesthesia, General or spinal, HELLP syndrome

References

• Audibert, F., Friedman, S. A., Frangieh, A. Y., & Sibai, B. M. (1996). Clinical utility of strict diagnostic criteria for the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. American Journal of Obstetrics and Gynecology, 175(2), 460–464. https://doi.org/10.1016/s0002-9378(96)70162-x
• Barton, J. R., & Sibai, B. M. (2009). Gastrointestinal complications of pre-eclampsia. Seminars in Perinatology, 33(3), 179–188.
• Bauer, M. E., Arendt, K., Beilin, Y., Gernsheimer, T., Perez Botero, J., James, A. H., Yaghmour, E., Toledano, R. D., Turrentine, M., Houle, T., MacEachern, M., Madden, H., Rajasekhar, A., Segal, S., Wu, C., Cooper, J. P., Landau, R., & Leffert, L. (2021). The Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia. Anesthesia and Analgesia, 132(6), 1531–1544. https://doi.org/10.1213/ANE.0000000000005355
• Chestnut DH. (1995). Anesthesia for the high risk obstetrical patient, vol. 234. Annual Refresher Course Lectures. Atlanta: American Society of Anesthesiologists, 1–7.
• D'Anna R. (1996). The HELLP syndrome. Notes on its pathogenesis and treatment. Minerva Ginecologica, 48(4), 147-154.
• Del-Rio-Vellosillo, M., & Garcia-Medina, J. J. (2016). Anesthetic considerations in HELLP syndrome. Acta Anaesthesiologica Scandinavica, 60(2), 144–157. https://doi.org/10.1111/aas.12639
• Haram, K., Svendsen, E., & Abildgaard, U. (2009). The HELLP syndrome: clinical issues and management. A Review. BMC Pregnancy and Childbirth, 9, 8. https://doi.org/10.1186/1471-2393-9-8
• Magann, E. F., & Martin, J. N., Jr (1999). Twelve steps to optimal management of HELLP syndrome. Clinical Obstetrics and Gynecology, 42(3), 532–550.
• Makris, A., Thornton, C., & Hennessy, A. (2004). Postpartum hypertension and nonsteroidal analgesia. American Journal of Obstetrics and Gynecology, 190(2), 577–578. https://doi.org/10.1016/j.ajog.2003.08.030
• Miranda, M. L., Vallejo-Vaz, A. J., Cerrillo, L., Marenco, M. L., Villar, J., & Stiefel, P. (2011). The HELLP syndrome (hemolysis, elevated liver enzymes and low platelets): Clinical characteristics and maternal-fetal outcome in 172 patients. Pregnancy Hypertension, 1(2), 164–169. https://doi.org/10.1016/j.preghy.2011.01.004
• Palit, S., Palit, G., Vercauteren, M., & Jacquemyn, Y. (2009). Regional anaesthesia for primary caesarean section in patients with preterm HELLP syndrome: a review of 102 cases. Clinical and Experimental Obstetrics & Gynecology, 36(4), 230–234.
• Roelofsen, A. C., van Pampus, M. G., & Aarnoudse, J. G. (2003). The HELLP-syndrome; maternal-fetal outcome and follow up of infants. Journal of Perinatal Medicine, 31(3), 201–208.
• Sibai, B. M., Taslimi, M. M., el-Nazer, A., Amon, E., Mabie, B. C., & Ryan, G. M. (1986). Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia-eclampsia. American Journal of Obstetrics and Gynecology, 155(3), 501–509. https://doi.org/10.1016/0002-9378(86)90266-8
• Sibai B. M. (2004). Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstetrics and Gynecology, 103(5 Pt 1), 981–991.
• Thiagarajah, S., Bourgeois, F. J., Harbert, G. M., Jr, & Caudle, M. R. (1984). Thrombocytopenia in preeclampsia: associated abnormalities and management principles. American Journal of Obstetrics and Gynecology, 150(1), 1–7.
• Weinstein L. (1985). Preeclampsia/eclampsia with hemolysis, elevated liver enzymes, and thrombocytopenia. Obstetrics and Gynecology, 66(5), 657–660.
• Weinstein L. (1982). Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. American Journal of Obstetrics and Gynecology, 142(2), 159–167.
• Wilke, G., Rath, W., Schutz, E., Armstrong, V. W., & Kuhn, W. (1992). Haptoglobin as a sensitive marker of hemolysis in HELLP-syndrome. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 39(1), 29–34. https://doi.org/10.1016/0020-7292(92)90776-
• Zeeman G. G. (2009). Neurologic complications of pre-eclampsia. Seminars in Perinatology, 33(3),166–172.