HELLP综合征的母胎结局

Maternal and fetal outcomes of HELLP syndrome

目的探讨HELLP综合征的母胎并发症及相关因素。方法回顾性分析2005年~2009年在本院分娩的32例HELLP综合征的临床资料,用χ2检验进行统计学分析。结果该综合征患者占同期重度子痫前期的2.16%（32/1 484）,诊断时的平均孕周为32周4 d（24＋~40周）,多发于27~37周。终止妊娠前发生的27例,发生在产后的均在48 h内发病。该综合征患者中完全HELLP 18例,部分HELLP即ELLP 14例,HELLP的母体并发症如子痫、胎盘早剥、产后出血、急性肾功不全等明显多于ELLP,当血小板≤50×109/L时,HELLP明显多于ELLP。孕周≤30周,死胎或死产、新生儿重度窒息明显增多,而且均表现为生长受限。初诊或急诊的HELLP患者多于定期产检的。结论HELLP较ELLP的母体并发症多,其严重程度与血小板计数有关,胎儿的病死率与发病时的孕周有关,定期产检可预防HELLP综合征的发病。

Objective To evaluate the related factors for adverse maternal and fetal outcome among women with HELLP syndrome.Methods We retrospectively analyzed maternal and fetal medical records of pregnancy complicated HELLP syndrome from January 1,2005 to December 31,2009.Related factors included maternal age,parity,gestational age at diagnosis,adverse maternal and fetal outcomes.Statistical analysis was performed with the χ2 test analysis.Results A total of 32 pregnant women with HELLP syndrome were reviewed.The incidence of HELLP or ELLP was 2.16% among the women with severe pre-eclampsia（32/1 484）.Gestational age at diagnosis was about 32 weeks and 4 days,with a peak frequency between the 27th and 37th gestational weeks.In about 84.4% of the cases,the HELLP syndrome developed before delivery.The rest developed in 48 h after delivery.The incidence of maternal complication,such as eclampsia,abruption placenta,postpartum bleeding,acute renal deficiency was higher among women with HELLP syndrome as compared with ELLP.The incidence of HELLP was significantly associated with a platelet nadir below 50×109/L（P0.05）.High incidence of fetal and neonatal death was present before 30 weeks of gestational age and with intrauterine growth restriction.High incidence of HELLP syndrome was also present in women without regular care during pregnancy.Conclusion The maternaladverse outcome of HELLP was higher than that of ELLP.There was a significant association between a platelet nadir below 50×109/L and the severity of HELLP.The perinatal mortality and morbidity were high before 30 weeks.Regular care during pregnancy may play an important role in preventing maternal and fetal adverse outcomes.