The Role of Hypertension for Maternal Outcomes of Women with HELLP Syndrome – a Retrospective Study from a Tertiary Obstetric Center

Abstract

Introduction

HELLP syndrome is a serious disorder that can occur in pregnancy; it has many possible complications and is associated with adverse maternal outcome. Due to the lack of predictive parameters for HELLP syndrome, finding the right time for delivery is challenging. In contrast to preeclampsia, hypertension is not an essential part of the diagnosis; nevertheless, many women with HELLP syndrome are hypertensive. The role and possible implications of hypertension in HELLP syndrome are not fully understood.

Material and Methods

In this retrospective cohort study, we analyzed the maternal outcomes of 59 patients diagnosed with HELLP syndrome. The patients were divided into three groups according to their blood pressure levels during their stay in hospital. These three groups were compared in terms of patient characteristics and maternal outcomes. A combined endpoint for adverse maternal outcome was defined which included blood pressure and antihypertensive medication at discharge from hospital, severe postpartum anemia, and eclampsia.

Results

Women with hypertensive crises had an unfavorable outcome compared to women with lower blood pressure levels. Patients with higher blood pressure during pregnancy were more likely to be hypertensive at discharge and needed a combination of antihypertensive agents significantly more often. The risk of an adverse maternal outcome increased with the severity of hypertension. An increase in systolic blood pressure by 10 mmHg raised the risk of an adverse outcome by 74% (95% CI: 1.22–2.66).

Conclusion

Hypertension not only plays an important role in preeclampsia but also affects the outcomes of patients with HELLP syndrome. These patients need to be identified quickly and treated accordingly as they are at risk of cardiovascular impairment. Patients should be followed up closely after delivery to reduce cardiovascular morbidity.

Zusammenfassung

Einleitung

Das HELLP-Syndrom stellt eine ernsthafte Schwangerschaftserkrankung dar; es ist mit vielen potenziellen Komplikationen behaftet und geht mit ungünstigen mütterlichen Outcomes einher. Da es an prädiktiven Parametern für das HELLP-Syndrom fehlt, ist es schwierig, den richtigen Zeitpunkt für die Entbindung zu ermitteln. Im Gegensatz zur Präeklampsie stellt das Auftreten einer Hypertonie keinen Bestandteil der Diagnose HELLP-Syndrom dar, dennoch haben viele Frauen mit HELLP-Syndrom Bluthochdruck. Die Rolle und die möglichen Implikationen einer Hypertonie beim HELLP-Syndrom sind noch nicht vollständig erforscht.

Material und Methoden

In dieser retrospektiven Kohortenstudie haben wir die mütterlichen Outcomes von 59 Patientinnen mit HELLP-Syndrom analysiert. Die Patientinnen wurden in 3 Gruppen unterteilt entsprechend ihrem jeweiligen Blutdruckniveau während ihres Aufenthalts im Krankenhaus. Die 3 Gruppen wurden bezüglich ihrer Patientencharakteristika und mütterlichen Outcomes verglichen. Es wurde ein kombinierter Endpunkt für ungünstiges mütterliches Outcome definiert, welcher den Blutdruck der Patientin und die Einnahme blutdrucksenkender Medikamente bei der Entlassung aus dem Krankenhaus, starke Anämie postpartal sowie das Auftreten einer Eklampsie einschloss.

Ergebnisse

Frauen mit hypertensiven Krisen hatten ein ungünstigeres mütterliches Outcome verglichen mit Frauen mit niedrigerem Blutdruck. Patientinnen mit Bluthochdruck während der Schwangerschaft hatten eher Bluthochdruck und benötigten signifikant häufiger eine Kombination blutdrucksenkender Mittel bei der Entlassung aus dem Krankenhaus. Das Risiko eines ungünstigen mütterlichen Outcomes nahm mit dem Schweregrad der Hypertonie zu. Eine Erhöhung des systolischen Blutdrucks um 10mmHg erhöhte das Risiko eines ungünstigen Ergebnisses um 74% (95%-KI [1.22–2.66]).

Schlussfolgerung

Die Hypertonie spielt nicht nur bei der Präeklampsie eine wichtige Rolle, sie beeinflusst auch das Outcome von Patientinnen mit HELLP-Syndrom. Diese Patientinnen müssen schnell identifiziert und entsprechend behandelt werden, da sie ein höheres Risiko für kardiovaskuläre Schäden haben. Ein engmaschiges Programm zur Überwachung dieser Patientinnen nach der Entbindung sollte eingeführt werden, um die kardiovaskuläre Morbidität zu senken.

Keywords

HELLP syndrome - arterial hypertension - hypertensive crisis - cardiovascular risk - hypertension in pregnancy

Schlüsselwörter

HELLP-Syndrom - arterielle Hypertonie - hypertensive Krise - kardiovaskuläres Risiko - Hypertonie in der Schwangerschaft

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