Long-term follow-up in patients with a history of (H)ELLP syndrome.

Abstract:

OBJECTIVE:To provide long-term follow-up data on women with a history of hemolysis, elevated liver enzymes, and low platelets [(H)ELLP] syndrome regarding the risk of recurrence in subsequent pregnancies and disease in later life. METHODS:All women admitted to the Academic Medical Centre between January 1984 and January 1996 with (H)ELLP syndrome and a living singleton fetus in utero were included. Women with known preexisting diseases were excluded. The (H)ELLP syndrome was defined as elevated liver enzymes (serum aspartate aminotransferase or serum alanine aminotransferase >or= 50 U/L) and low platelet count (< 100 x 10(9)/L). Those patients with hemolysis (LDH >or= 600 U/L) were classified as HELLP, the remaining ones were classified as ELLP. The participants were asked to fill out a questionnaire regarding their general health and their own obstetric and medical history and that of their first-and second-degree relatives. RESULTS:One hundred sixteen (94%) of 123 women responded; 4 women had died. The median age of the group was 36.0 years at completion of the questionnaire; the median interval after the index pregnancy was 5.7 years (3-12.9). The incidence of hypertension requiring medical treatment was three times higher than in a reference population of Dutch women between 20 and 40 years old. The need for psychological support was frequent. Thirty-nine patients (34%) refrained from further pregnancies. Twenty-nine percent of the first subsequent pregnancies were complicated by gestational hypertension (GH), but only 2% had (H)ELLP syndrome. Birth weight was, on average, 1385 g higher and gestational age at delivery 5 weeks later in the first subsequent pregnancy irrespective of a recurrence of GH. A family history of cardiovascular disease or preeclampsia was common in the total group; however, this did not influence the recurrence rate. Multiparity, gestational age at delivery <30 weeks, and birth weight <1000 g in the index pregnancy increased the risk of recurrence of GH in the first subsequent pregnancy significantly. CONCLUSIONS:(H)ELLP syndrome is a severe complication of pregnancy that has not only short-term but also long-term sequelae.

journal_name

Hypertens Pregnancy

authors

van Pampus MG,Wolf H,Mayruhu G,Treffers PE,Bleker OP

doi

10.1081/PRG-100104168

keywords:

subject

Has Abstract

pub_date

2001-01-01 00:00:00

pages

15-23

issue

1

eissn

1064-1955

issn

1525-6065

pii

100104168

journal_volume

20

pub_type

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