Comparative study of fetomaternal outcome in patients with pregnancy-induced hypertension with and without hemolysis, elevated liver enzymes, and low platelets syndrome: a tertiary care center study

Abstract Background: Hypertensive disorders of pregnancy, especially preeclampsia, remain major global public health challenges and leading causes of maternal illness and death. Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, which involves hemolysis, elevated liver enzymes, and low platelet count, is a severe subtype of preeclampsia linked to significant maternal and neonatal complications. Objectives: This study aimed to compare fetomaternal outcomes in patients with pregnancy-induced hypertension (PIH) with and without HELLP syndrome. Materials and Methods: A prospective, observational, comparative study was carried out involving 100 pregnant women. Group 1 included 50 women with PIH without HELLP syndrome, while Group 2 consisted of 50 women with PIH and HELLP syndrome, diagnosed using the Tennessee criteria. Maternal parameters (such as acute kidney injury, disseminated intravascular coagulation [DIC], and mode of delivery) and neonatal outcomes (including intra uterine fetal death and respiratory distress) were evaluated. A P value less than 0.05 was considered statistically significant. Results: Women in Group 2 (HELLP syndrome) showed significantly higher mean systolic blood pressure (167.8 mm Hg vs. 150.8 mm Hg, P = 0.02) and delivered at a significantly earlier gestational age (32 weeks vs. 36.6 weeks). Cesarean section rates were markedly higher in Group 2 (92% vs. 66%, P < 0.00001). Group 2 also had significantly lower mean hemoglobin levels (8.18 g/dL vs. 9.18 g/dL, P = 0.0007), a higher incidence of acute kidney injury (16% vs. 4%, P = 0.0455), DIC (12% vs. 2%, P = 0.05), increased need for blood product transfusion (42% vs. 16%, P = 0.004), and higher rates of neonatal respiratory distress (24% vs. 8%, P = 0.029). Intrauterine fetal death and intraventricular hemorrhage were also slightly more common in Group 2 ( P = 0.050 for both). Conclusion: HELLP syndrome significantly worsens maternal and neonatal complications in patients with PIH. These findings emphasize the importance of prompt management and access to multidisciplinary care at tertiary healthcare centers for the best outcomes.