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Martin Jr., J.N., Brewer, J.M., Wallace, K., Sunesara, I., Canizaro, A., Blake, P.G., Lamarca, B. and Owens, M.Y. (2013) HELLP Syndrome and Composite Major Maternal Morbidity: Importance of Mississippi Classification System. The Journal of Maternal-Fetal & Neonatal Medicine, 26, 1201-1206.
https://doi.org/10.3109/14767058.2013.773308

has been cited by the following article:

• TITLE: Pregnant-Postpartum Women with Severe Epigastric Pain and HELLP Syndrome: A Highly Dangerous Combination

  AUTHORS: James Nello Martin Jr., James Martin Tucker

  KEYWORDS: HELLP SYNDROME with or without Epigastric Pain, Maternal Morbidity & Mortality, LDH to AST Ratio

  JOURNAL NAME: Open Journal of Obstetrics and Gynecology, Vol.11 No.8, August 30, 2021

  ABSTRACT: OBJECTIVE: HELLP syndrome is a severe preeclampsia spectrum disorder diagnosed when laboratory evidence of hemolysis, liver dysfunction and thrombocytopenia are present. The presence of epigastric pain with laboratory criteria for HELLP syndrome may indicate higher maternal-fetal risk. Thus we explored maternal outcomes in 42 pregnant/postpartum women that had HELLP syndrome by laboratory criteria in addition to sudden severe epigastric pain. METHODS: A database was constructed from the medical files of all patients with medical/hypertensive disorders evaluated by the first author from 1986-2015 for medicolegal purposes. All patient files of women who presented to their physicians with a diagnosis of presumptive HELLP syndrome were examined. RESULTS: Fifty-eight pregnant/postpartum women fulfilled study inclusion criteria; they presented to physicians for evaluation usually in non-tertiary care hospital settings. Clinical presentation and care including lab data and details of pregnancy outcome were evaluated. A correct diagnosis of HELLP syndrome was verified for 42 women (72.4%); others were determined to have AFLP-Acute Fatty Liver of Pregnancy (n = 8) or TTP-aHUS-Thrombotic thrombocytopenic purpura-adult/atypical hemolytic uremic syndrome (n = 8). All 42 HELLP women (100%) in our cohort had severe epigastric pain. Treatment modalities for maternal HELLP syndrome included magnesium sulfate (n = 35, 83%), antihypertensives (n = 17, 40%); corticosteroids (CORT) for HELLP were not utilized. Major maternal morbidity (21 strokes, 9 liver ruptures/hematomas) affected 41 HELLP women (98%); 22 died, 7 were permanently disabled. CONCLUSION: HELLP syndrome patients presenting with sudden, severe epigastric pain in this highly selected cohort experienced very high maternal morbidity and mortality. Laboratory evidence of HELLP syndrome in association with epigastric pain is a dangerous combination that portends great danger to safe motherhood. We speculate that the absence of CORT use in this cohort contributed to poor maternal outcome (word count = 280 as modified for reviewers).