(1100) Normotensive vs. Hypertensive HELLP Syndrome: Should We Expect Different Outcomes?

To compare maternal and neonatal outcomes between women with hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome with and without associated hypertension, focusing on differences in presentation, disease severity, and associated complications.

Study Design: A retrospective cohort study of singleton deliveries diagnosed with HELLP syndrome at a tertiary university-affiliated hospital (1.2011-3.2023). Cases were categorized into normotensive HELLP and hypertensive HELLP. We collected and compared data on maternal demographics, clinical presentation, laboratory findings, delivery outcomes, and neonatal complications.

Results:

Among 157,282 deliveries, 118 met the full criteria for HELLP syndrome: 74 (68.5%) hypertensive and 34 (31.5%) normotensive. Normotensive HELLP cases were diagnosed at a significantly later gestational age (37.5 ± 3.0 vs. 34.5 ± 4.4 weeks, p< 0.001). Only 2 women (5.9%) with normotensive HELLP delivered < 34 weeks, compared to 33 (44.6%) with hypertensive HELLP (p < 0.001) (figure). Proteinuria was less common in normotensive cases (58.8% vs. 87.8%, p< 0.001). Laboratory parameters, including hemoglobin, platelet count, creatinine, liver function tests, and hemolysis parameters, did not differ significantly between the groups. Neonates in the normotensive group had significantly higher mean birth weights (2574.6 ± 746.2 vs. 1947 ± 816.6 grams, p< 0.001), fewer NICU admissions (29.4% vs. 56.8%, p=0.008), and lower rates of respiratory distress syndrome (2.9% vs. 24.3%, p=0.007) (figure). Maternal complications related to HELLP syndrome did not differ significantly between normotensive and hypertensive cases (figure).

Conclusion:

Normotensive HELLP syndrome appears to be a less severe form of HELLP syndrome, presenting at a later gestational age. Despite differences in neonatal outcomes, maternal adverse outcomes remain comparable to those in hypertensive HELLP syndrome. This suggests that normotensive HELLP should be managed with the same caution as hypertensive HELLP to ensure optimal maternal and neonatal outcomes.