THE INTRAPARTUM PLATELET COUNT IN PATIENTS WITH HELLP (HEMOLYSIS, ELEVATED LIVER-ENZYMES, AND LOW PLATELETS) SYNDROME - IS IT PREDICTIVE OF LATER HEMORRHAGIC COMPLICATIONS

OBJECTIVE: We wished to determine in patients with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) whether (1) there is an intrapartum threshold platelet count that is predictive of immediate or delayed hemorrhagic complications and (2) whether prophylactic platelet transfusion at delivery prevents these outcomes. STUDY DESIGN: In this retrospective, descriptive study, the peripartal courses of 132 patients with class 1 (less than or equal to 50,000/mu l platelet nadir) and 160 patients with class 2 (> 50,000 but less than or equal to 100,000/mu l platelet nadir) HELLP syndrome were reviewed with special attention to laboratory data, evidence of hemorrhage, and details of platelet transfusion therapy. RESULTS: A higher incidence of postpartum hemorrhagic complications (p < 0.001) occurred in class 1 versus class 2 HELLP pregnancies. The tendency to have postpartum incisional bleeding after abdominal or vaginal delivery was related to the degree of thrombocytopenia (p = 0.006). The antepartum threshold platelet count most predictive of subsequent postpartum hemorrhagic complications was less than or equal to 40,000/mu l. The prophylactic administration of platelets does not appear to have either significantly decreased the incidence of postpartum hemorrhagic complications or significantly hastened normalization of the postpartum platelet count. CONCLUSIONS: Although bleeding in the gravid patient is related to more factors than platelet count alone, patients with HELLP syndrome in whom an intrapartum platelet count above 40,000/mu l is maintained are unlikely to have clinically significant postpartum bleeding. Patients with intrapartum platelet counts less than or equal to 40,000/mu l, however, are at significant risk for postpartum bleeding, but prophylactic platelet transfusion at delivery does not ensure a significantly lower incidence of postpartum hemorrhagic complications.