Standard Parameters of Preeclampsia: Can the Clinician Depend Upon Them to Reliably Identify the Patient with the HELLP Syndrome?

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EDITORIAL COMMENT: We accepted the following 3 gapers concerned with the HELLPsyndmme (haemolysis, elwated liver enzymes and low platelets) becuuse a series of 454 cases merits attention and we asked the authors to explain how they gathered such a large series. It has been standard teaching to recommend delivery of the patient with swere preeclampsia, more or less irrespective of the period of gestation. At times this ruling is not followed when the baby is judged to be immature. There is also the question of whether betamethasone thempy should be used when these women are treated conservatively. Readers should note that the authors are not recommending comernative management of women with severe preeelampsia and the HELLPsyndrome. TWO of these 3 paperspresent results in 270f the 427patients (6.3 %)given corticosteriods when it was judged pmper practice to allow conservative management for a few days. Our senior miewer from the Royal Women's Hospitai, Melbourne, calculated that in our community we would need about 225,000pregnancies to obtain 454 cases of the HELLPsyndrome (preeclampsia 2% and the HELLPsyndmme in 10% of these). ‘The syndrome described is really one of thrornbocytopenia and hyperuricaemia. The authors do not define their criteria for haemolysis or elevated liver enzymes. The value of classijication of the severity of the HELLP syndmme on the basis of the platelet count is questioned since the worst prognosis in these cases is when there is consumptive eoagulopathy, microhaemangiopathic anaemia and epigastric pain in association with impaired liver function’. The senior author was asked to explain the source of the series and the clussification of severity of the condition and he provided the following: