Prevalence, Clinical Characteristics, and Factors Independently Associated with Complete HELLP Syndrome among Women with Eclampsia in Bangladesh: A Hospital-Based Cross-Sectional Study

Background: HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet count) syndrome is a severe complication of hypertensive disorders of pregnancy associated with substantial maternal and neonatal morbidity. Evidence regarding its burden and associated factors among women with eclampsia in Bangladesh remains limited. Objectives: This study determined the prevalence of complete HELLP syndrome and identified factors independently associated with its occurrence. Methods: A hospital-based cross-sectional study was conducted among 150 consecutive women with eclampsia admitted to the Department of Obstetrics and Gynaecology, Khawja Yunus Ali Medical College Hospital, Bangladesh, between July 2023 and December 2025. Complete HELLP syndrome was diagnosed using the Tennessee Classification System. Sociodemographic, obstetric, clinical, and laboratory data were analyzed using multivariable logistic regression. Results: Complete HELLP syndrome was diagnosed in 28 women, yielding a prevalence of 18.7% (95% CI: 13.2–25.7%). Women with HELLP syndrome had significantly higher blood pressure, serum creatinine, aspartate aminotransferase, and lactate dehydrogenase levels, and markedly lower platelet counts than those without HELLP syndrome (all P<0.01). Referral from another healthcare facility (adjusted odds ratio [AOR] 11.85, 95% CI: 3.46–40.55) and serum creatinine ≥1.1 mg/dL (AOR 6.98, 95% CI: 1.71–28.53) were independently associated with complete HELLP syndrome. Maternal ICU admission, neonatal death, and neonatal intensive care unit admission occurred more frequently among women with HELLP syndrome. Conclusions: Nearly one in five women with eclampsia had complete HELLP syndrome. Delayed referral and renal dysfunction were independently associated with the condition, underscoring the importance of early referral, routine laboratory screening, and timely multidisciplinary management to improve maternal and neonatal outcomes in resource-limited settings. J Com Med Col Teachers’ Asso July 2026; 30(2): 127-133