Prognosis

The maternal mortality rate in HELLP syndrome is about 1% to 2% but may vary depending on location and access to medical care. In 32 published series involving 2346 patients with HELLP syndrome managed worldwide between 2001 and 2011, there were 77 deaths (3.3%), 53 strokes, and 178 cases of acute renal failure.[15] A management plan involving the aggressive use of corticosteroids, magnesium sulfate and prevention of severe systolic hypertension was not systematically provided for these patients.

Disease course

One case control study using the UK Obstetric Surveillance System included the findings from 129 patients with HELLP syndrome and 81 patients with partial HELLP syndrome. In the study, 95% of patients were delivered within 48 hours. Patients with HELLP syndrome were significantly more likely to require blood products and to have severe maternal morbidity (13%) compared with women with partial HELLP syndrome (1%).[98]

Recurrence

The recurrence risk is relatively low (2% to 6%), although in some populations the recurrence is 15% to 20%. However, up to 20% to 40% of normotensive patients with a history of prior HELLP syndrome will have some form of preeclampsia in a subsequent pregnancy. This rate increases to 75% in those with underlying hypertensive disorders.[99][100][101][102] Currently, there is no effective intervention to prevent the recurrence of HELLP syndrome.

Long-term disease associations

Hypertensive disorders of pregnancy are associated with an increased risk of cardiovascular disease in later life.[103] However, there is currently a lack of understanding of preeclampsia subtypes, which include differences in the timing of onset in pregnancy, the presence of severe features and the association of intrauterine growth restriction. These features may have different long-term implications for cardiovascular risk.[104] Regular assessment of cardiovascular risk factors in women who have had hypertensive disorders of pregnancy provides an opportunity for prevention interventions.[105]

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