Risk factors for post-partum complications occurring after preeclampsia and HELLP syndrome - A study in 453 consecutive pregnancies

Objective: To evaluate complications that occurred during the post-partum period for patients with preeclampsia or HELLP syndrome. Study design: Retrospective analysis of 453 patients. The main outcome measures were matemal complications during post-partum period: fever > 38.5 degrees C with proved infection, abdominal or perineal abscess, thrombo-embolic events, reoperation, need for blood transfusion, acute renal failure, eclampsia or disseminated intravascular coagulation. Statistic tests included univariate and multivariate analysis with stepwise descending logistic regression. Results: Patients were divided into 305 preeclampsia (67.3%) and 20 HELLP syndrome (4.4%), 128 (28.3%) had both. Eighty-five patients (18.8%) had at least one post-partum complication. The most frequent complication was infection: fever (41 patients, 9.1%) and abscess (30 patients, 6.6%). Twenty-six transfusions (5.7%), 10 disseminated intravascular coagulation (2.2%), seven thromboembolic events (1.5%), seven reoperations (1.5%) and one eclampsia (0.2%) were observed. There was no acute renal failure, no pulmonary oedema and no maternal death. Stepwise logistic regression showed five independent risk factors associated with post-partum complications: ascites or pulmonary oedema (OR: 1.84 95% CI: 1.01-3.37), platelet count < 100 000/mm(3) (OR: 1.96, 95% CI: 1.18-3.26), serum acid uric > 360 mu mol/l (OR: 2.36, 95% CI: 1.22-4.52), serum creatinine > 120 mu mol/l (OR: 2.99, 95% CI: 1.32-6.78), and proteinuria > 5 g/l (OR: 1.80, 95% CI: 1.06-3.05). Conclusion: We conclude that severity criteria for preeclampsia or HELLP syndrome combined with caesarean section increased the risk of complication during the post-partum period. (c) 2005 Elsevier Ireland Ltd. All rights reserved.