Perinatal outcomes in normotensive versus hypertensive <scp>HELLP</scp> syndrome

OBJECTIVE: To compare maternal and neonatal outcomes between women with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome with and without associated hypertension. METHODS: This was a retrospective cohort study at a tertiary university-affiliated medical center including all singleton HELLP cases >24 weeks gestation (January 2011-March 2023). Cases were categorized as normotensive or hypertensive HELLP and compared for demographics, presentation, laboratory findings, and outcomes. RESULTS: Among 157 282 deliveries, 108 met the full criteria for HELLP syndrome: a total of 74 (68.5%) were hypertensive and 34 (31.5%) were normotensive. Normotensive HELLP cases were diagnosed at a significantly later gestational age (37.5 ± 3.0 vs 34.5 ± 4.4 weeks, P < 0.001). Proteinuria was less common in normotensive cases (58.8% vs 87.8%, P < 0.001). Laboratory parameters did not differ significantly between the groups. Neonates in the normotensive group had significantly higher mean birth weight (2574.6 ± 746.2 vs 1947 ± 816.6 g, P < 0.001), fewer neonatal intensive care admissions (29.4% vs 56.8%, P = 0.008), and lower rates of respiratory distress syndrome (2.9% vs 24.3%, P = 0.007). Maternal complications related to HELLP syndrome did not differ significantly between groups. CONCLUSION: Normotensive HELLP was diagnosed at a later gestational age and was associated with more favorable neonatal outcomes, yet comparable maternal outcomes. Despite the absence of hypertension, maternal complications were not reduced.