HELLP Syndrome: Predictive Factors and Benefits of a Standardized Treatment Protocol in a Cohort of 1,254 Cases of Preeclampsia

Abstract

Introduction: HELLP syndrome (Hemolysis, Elevated Liver Enzymes, Low Platelets) is one of the most severe complications of preeclampsia, posing a life-threatening risk to both mother and fetus. In middle-income countries, its management is complicated by delays in consultation and limited resources. This study aims to determine the incidence of the syndrome, its predictive factors, and to evaluate the impact of a standardized protocol on morbidity and mortality. Methods: An analytical, comparative, prospective, and interventional study was conducted over four years at Annaba University Hospital, including 1,254 patients with preeclampsia. The study was designed to compare two consecutive periods: an initial observational phase (T1), conducted before the implementation of any standardized protocol, and an interventional  phase (T2), following the introduction of a multidisciplinary management protocol incorporating antenatal corticosteroid therapy, conservative (expectant) management, and structured fluid management. Results: Among 1,254 women with preeclampsia, 223 developed HELLP syndrome, corresponding to an incidence of 17.8%. The clinical presentation was dominated by hepatic cytolysis, observed in 197 cases (88.3%), and severe thrombocytopenia (<100,000/mm³) in 160 cases (71.8%). Acute renal failure complicated 153 cases (68.6%), reflecting delayed diagnosis and management. Implementation of the multidisciplinary management protocol during the interventional phase (T2) was associated with a significant reduction in neonatal mortality (35.6% vs. 44.4%; p = 0.0087), as well as a decrease in platelet transfusion requirements (p = 0.004) and a shorter maternal length of hospital stay (p < 0.0001). Importantly, this more conservative, expectant approach did not increase maternal morbidity. Conclusion: Standards of care are changing the prognosis for HELLP syndrome. A conservative approach between 28 and 34 weeks of gestation is beneficial and safe in our setting, when strict monitoring is in place.