Microcirculation in women with severe pre-eclampsia and HELLP syndrome: a case-control study

ObjectiveTo compare microcirculatory perfusion in women with severe pre-eclampsia against that in healthy pregnant women, and secondly in women with severe pre-eclampsia with or without HELLP syndrome (haemolysis, elevated liver enzymes, and low platelets). DesignCase-control study. SettingUniversity Hospital Rotterdam, the Netherlands. PopulationTwenty-three women with severe pre-eclampsia and 23 healthy pregnant controls, matched for maternal and gestational age. Out of the 23 women with severe pre-eclampsia, ten presented with HELLP syndrome. MethodsMicrocirculation was analysed sublingually by a non-invasive sidestream dark-field imaging device (SDF). Main outcome measuresPerfused vessel density (PVD), microcirculatory flow index (MFI), and heterogeneity index (HI) were calculated for both small vessels (empty set <20m; capillaries) and non-small vessels (<empty set>>20m; venules and arterioles). ResultsThere were no significant differences between women with severe pre-eclampsia and healthy controls. Women with pre-eclampsia and HELLP syndrome showed a reduced PVD (P=0.045), MFI (P=0.008), and increased HI (P=0.002) for small vessels, as compared with women with pre-eclampsia but without HELLP syndrome. ConclusionsSidestream dark-field is a novel, promising technique in obstetrics that permits the non-invasive evaluation of microcirculation. We did not observe major differences in sublingual microcirculatory perfusion between women with severe pre-eclampsia and healthy pregnant controls. In women with severe pre-eclampsia, the presence of HELLP syndrome is characterised by impaired capillary perfusion.