Factors and clinical features associated with development of hellp syndrome among patients with preeclampsia with severe features at the Kenyatta National Hospital

Abstract

Background HELLP syndrome is considered a complication of preeclampsia with severe features; which is one of the hypertensive diseases in pregnancy. It is still not well understood why some patients with severe preeclampsia develop HELLP while others do not. HELLP syndrome contributes to considerable morbidity and mortality in both the mother and the fetus.Understanding the factors and clinical features associated with the development of HELLP syndrome among patients with severe preeclampsia would help clinicians have a high index of suspicion and thus identify patients at risk early and manage them appropriately to prevent adverse maternal and perinatal outcomes associated with the condition. Study Objectives: Among patients withpreeclampsia with severe feature, to determine the socio-demographic, obstetric and clinico-pathological characteristics of patients with and without HELLP syndrome; and the association between preeclampsia and the development of HELLP syndrome. Methodology: This study adopted a case control study design. Data was collected from 316 records of patients with a diagnosis of PE with severe features, who attended maternity and delivery services at the Kenyatta National Hospital (KNH) for the period January 2014 to December 2016. The cases comprised of 97 records of patients with a diagnosis of PE with severe features and HELLP syndrome. The controls comprised of 219 records of patients with PE with severe features without HELLP syndrome. Data on socio demographic, obstetric and clinical factors was extracted from the patient records and an association between a diagnosis of severe preeclampsia and development of HELLP syndrome established. Socio demographic data was presented in form of tables. Multivariate analysis was conducted using SPSS version 21 to establish any association between the factors and clinical features and the development of HELLP syndrome. The study findings were presented in tabular form. A level of significance of 0.05 was taken as significant statistically. Results: A total of 316 records of patients with PE with severe features were reviewed. Cases comprised 97 records of patients with HELLP syndrome while controls comprised 219 records of patients without HELLP syndrome. The mean age of patients with HELLP syndrome was 29.5 years. There was a statistically significant association between having a history of epigastric pain and development of HELLP syndrome. Elevated levels of creatinine of more than 110 micromoles/ml also increased the risk of developing HELLP syndrome 4 fold.There was no association between education level, marital status and age and the development of HELLP syndrome. Similarly, parity, gestational age and a previous history of PE or HELLPdid not increase the risk of developing HELLP syndrome. A history of headache, blurring of vision, level of blood pressure and proteinuria did not increase the risk of developing HELLP syndrome as well. Conclusion: Significant risk factors for developing HELLP syndrome were a positive history of epigastric pain and elevated creatinine levels > 110 micromoles/litre.