The spectrum of severe preeclampsia: comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification

Am J Obstet Gynecol. 1999 Jun;180(6 Pt 1):1373-84. doi: 10.1016/s0002-9378(99)70022-0.


Objective: This study was undertaken to explore the spectrum of maternal disease with a triple classification system of HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome and compare these classes with severe preeclampsia without HELLP syndrome.

Study design: In this retrospective analytic study the pregnancies of 777 patients with class 1, 2, or 3 HELLP syndrome were compared and contrasted with those of 193 women with severe preeclampsia but without HELLP syndrome.

Results: Eclampsia, epigastric pain, nausea and vomiting, significant proteinuria, major maternal morbidity, and stillbirth increased as HELLP syndrome worsened from class 3 to class 1. In contrast, headache and diastolic hypertension were more common among the significantly heavier patients with severe preeclampsia without HELLP syndrome. Approximately half of pregnancies complicated by class 1 HELLP syndrome exhibited significant maternal morbidity, compared with only 11% of those complicated by severe preeclampsia without HELLP syndrome. Although a significant trend was apparent in increasing levels of lactate dehydrogenase, aspartate aminotransferase, and uric acid as HELLP syndrome worsened, there was considerable variation within groups.

Conclusion: Laboratory and clinical indices of disease severity in patients with severe preeclampsia or eclampsia generally were highest with class 1 HELLP syndrome and were lowest when HELLP syndrome was absent. Class 3 HELLP syndrome is considered a clinically significant transitional group.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aspartate Aminotransferases / blood
  • Birth Weight
  • Cesarean Section
  • Eclampsia / complications
  • Female
  • Fetal Death
  • HELLP Syndrome / classification*
  • HELLP Syndrome / complications
  • HELLP Syndrome / physiopathology
  • Headache
  • Humans
  • Hypertension
  • L-Lactate Dehydrogenase / blood
  • Nausea
  • Pre-Eclampsia / complications
  • Pre-Eclampsia / physiopathology*
  • Pregnancy
  • Proteinuria
  • Uric Acid / blood
  • Vomiting


  • Uric Acid
  • L-Lactate Dehydrogenase
  • Aspartate Aminotransferases