HELLP syndrome as a major contributor to adverse maternal and neonatal outcomes among preeclamptic women: findings from a multicenter retrospective cohort study

Abstract

OBJECTIVE: HELLP syndrome, a severe complication of preeclampsia, is associated with increased maternal and neonatal morbidity and mortality. This study aims to evaluate maternal and perinatal outcomes in preeclamptic women with and without HELLP syndrome in Indonesia. METHODS: A multicenter retrospective cohort study was conducted across 30 hospitals in Indonesia from January 2022 to December 2023. Data from 1,808 preeclamptic women were analyzed, with 219 (12.1%) classified as having HELLP syndrome. Maternal and perinatal outcomes were compared between the HELLP and non-HELLP groups. RESULTS: Women with HELLP syndrome had significantly higher risks of severe complications, including eclampsia (p < 0.001; aOR: 2.5 (1.5-4.18)), acute kidney injury (p < 0.01; aOR: 4.11 (2.07-8.15)), emergency hypertension (p = 0.048; aOR: 1.42 (1.01-2.01)), preterm birth < 37 weeks (p = 0.013; aOR: 1.54 (1.1-2.17)), and preterm birth < 34 weeks (p < 0.001; aOR: 1.8 (1.28-2.53)). HELLP syndrome increased the risk of Intra-uterine fetal death (p = 0.01; aOR: 2.18 (1.21-3.95)) and neonatal sepsis (p = 0.011; aOR: 2.32 (1.21-4.42)). Although the multivariate analysis did not yield any significant results, the HELLP syndrome group has a substantially higher prevalence of maternal death (3.7% vs 1%; p = 0.005) and neonatal death (11.6% vs 6.4%; p = 0.005). CONCLUSION: HELLP syndrome significantly worsens maternal and neonatal outcomes in preeclampsia, reflecting a need for improved early detection of 'high-risk' preeclamptic women like sFlt1/PLGF ratio and perhaps other laboratory tests like haptoglobin and D-dimer's. Many of these laboratory tests are currently not accessible in the Indonesian public health sector. Further research is needed to identify other markers that would assist in a more timely diagnosis of impending HELLP syndrome, particularly in early-onset preeclampsia patients managed conservatively.

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