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The following is a summary of “HELLP syndrome at <23 weeks’ gestation: a systematic literature review,” published in the NOVEMBER 2023 issue of Obstetrics and Gynecology by Mossayebi, et al.

For a systematic review, researchers sought to assess the clinical presentation, as well as maternal and fetal outcomes, in pregnancies affected by early-onset HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.

The review sourced data from PubMed, Ovid MEDLINE, Scopus, CINAHL, Cochrane Library, and ClinicalTrials.gov, covering the period from inception through January 1, 2023. Relevant terms, including variations of HELLP syndrome and gestational timeframes, were used in the search. An additional case from the authors’ institution was included. Abstracts, unpublished studies, and reviews were excluded. The inclusion criteria resulted in 46 studies being considered. Two independent reviewers, N.S.I. and M.H.M., independently conducted the study selection and data extraction. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study was registered at PROSPERO.

Early-onset HELLP syndrome was identified in 58 pregnancies involving 55 patients, including 3 with recurrent HELLP. Common presenting signs/symptoms included abdominal pain (78%), hypertension (65%), nausea/vomiting (36%), headache (29%), and edema (18%). Laboratory abnormalities included elevated lactate dehydrogenase (68%), liver enzymes (94%), and thrombocytopenia (93%). Maternal complications occurred in 45% of cases, with hepatic (23%), central nervous system–related (20%), and respiratory (20%) complications being the most frequent. Termination of pregnancy occurred in 63% of cases. Continued pregnancies had poor fetal outcomes, with early fetal death (48%), stillbirth (28%), and neonatal demise (10%) reported. Living neonates were reported in 14% of cases, all delivered at 23 weeks. The perinatal mortality rate was 73%, and one case (2%) reported maternal death. Antiphospholipid syndrome was diagnosed in 48% of cases.

Early-onset HELLP syndrome mirrors symptoms seen in later gestation but is associated with life-threatening maternal complications, particularly hepatic, central nervous system–related, and respiratory issues. Fetal outcomes were generally unfavorable, emphasizing the severity of the condition.

Source: ajog.org/article/S0002-9378(23)00284-3/fulltext