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Bahaeddine M Sibai - One of the best experts on this subject based on the ideXlab platform.
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diagnosis controversies and management of the syndrome of hemolysis elevated liver enzymes and Low Platelet Count
Obstetrics & Gynecology, 2004Co-Authors: Bahaeddine M SibaiAbstract:Hemolysis, elevated liver enzymes, and Low Platelets (HELLP) syndrome has been recognized as a complication of preeclampsia‐ eclampsia for decades. Recognition of this syndrome in women with preeclampsia is increasing because of the frequency of blood test results that reveal unexpected thrombocytopenia or elevated liver enzymes. The diagnosis of HELLP syndrome requires the presence of hemolysis based on examination of the peripheral smear, elevated indirect bilirubin levels, or Low serum haptoglobin levels in association with significant elevation in liver enzymes and a Platelet Count beLow 100,000/mm 3 after ruling out other causes of hemolysis and thrombocytopenia. The presence of this syndrome is associated with increased risk of adverse outcome for both mother and fetus. During the past 15 years, several retrospective and observational studies and a few randomized trials have been published in an attempt to refine the diagnostic criteria, to identify risk factors for adverse pregnancy outcome, and to treat women with this syndrome. Despite the voluminous literature, the diagnosis and management of this syndrome remain controversial. Recent studies suggest that some women with partial HELLP syndrome may be treated with expectant management or corticosteroid therapy. This review will emphasize the controversies surrounding the diagnosis and management of this syndrome. Recommendation for diagnosis, management, and counseling of these women is also provided based on results of recent studies and my own clinical experience. (Obstet Gynecol 2004;103:981‐91. © 2004 by The American College of Obstetricians and Gynecologists.)
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diagnosis controversies and management of the syndrome of hemolysis elevated liver enzymes and Low Platelet Count
Obstetrics & Gynecology, 2004Co-Authors: Bahaeddine M SibaiAbstract:Hemolysis, elevated liver enzymes, and Low Platelets (HELLP) syndrome has been recognized as a complication of preeclampsia-eclampsia for decades. Recognition of this syndrome in women with preeclampsia is increasing because of the frequency of blood test results that reveal unexpected thrombocytopenia or elevated liver enzymes. The diagnosis of HELLP syndrome requires the presence of hemolysis based on examination of the peripheral smear, elevated indirect bilirubin levels, or Low serum haptoglobin levels in association with significant elevation in liver enzymes and a Platelet Count beLow 100,000/mm(3) after ruling out other causes of hemolysis and thrombocytopenia. The presence of this syndrome is associated with increased risk of adverse outcome for both mother and fetus. During the past 15 years, several retrospective and observational studies and a few randomized trials have been published in an attempt to refine the diagnostic criteria, to identify risk factors for adverse pregnancy outcome, and to treat women with this syndrome. Despite the voluminous literature, the diagnosis and management of this syndrome remain controversial. Recent studies suggest that some women with partial HELLP syndrome may be treated with expectant management or corticosteroid therapy. This review will emphasize the controversies surrounding the diagnosis and management of this syndrome. Recommendation for diagnosis, management, and counseling of these women is also provided based on results of recent studies and my own clinical experience.
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risk factors for adverse maternal outcomes among women with hellp hemolysis elevated liver enzymes and Low Platelet Count syndrome
American Journal of Obstetrics and Gynecology, 2000Co-Authors: Bassam Haddad, John R Barton, Jeffrey Livingston, Rabih Chahine, Bahaeddine M SibaiAbstract:Abstract Objective: This study was undertake to determine risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and Low Platelet Count) syndrome. Study Design: Maternal medical records of pregnancies complicated by HELLP syndrome managed between July 1, 1992, and April 30, 1999, were reviewed. Risk factors evaluated included maternal age, parity, race, previous preeclampsia, chronic hypertension, gestational age at diagnosis, mean arterial blood pressure, nadir blood Platelet Count ( t test, the χ 2 test, and logistic regression analysis. Results: A total of 183 women with HELLP syndrome were studied. Eclampsia was present in 6%, abruptio placentae was present in 10%, and disseminated intravascular coagulopathy was present in 8%. Forty-one women (22%) required transfusion of blood products. Incidence of eclampsia significantly decreased with increasing gestational age, from 16% at ≤28 weeks' gestation to 3% at >32 weeks' gestation ( P P P P P P 150 U/L, and a peak serum lactate dehydrogenase level of >1400 U/L were not independent risk factors for adverse outcome. Conclusions: Among women with HELLP syndrome, African American race is a risk factor for eclampsia. Both acute renal failure and abruptio placentae are associated with disseminated intravascular coagulopathy. Laboratory parameters of HELLP syndrome are not independent risk factors for adverse maternal outcome. (Am J Obstet Gynecol 2000;183:444-8.)
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neonatal outcome in severe preeclampsia at 24 to 36 weeks gestation does the hellp hemolysis elevated liver enzymes and Low Platelet Count syndrome matter
American Journal of Obstetrics and Gynecology, 1999Co-Authors: Dorel Abramovici, Steven A Friedman, Brian M Mercer, Francois Audibert, Lu Kao, Bahaeddine M SibaiAbstract:Abstract Objective: Our purpose was to compare neonatal outcome after preterm delivery of infants whose gestation was complicated by the HELLP (hemolysis, elevated liver enzymes, and Low Platelet Count) syndrome, partial HELLP syndrome, or severe preeclampsia. Study Design: We reviewed the maternal and neonatal charts from 269 consecutive pregnancies complicated by the HELLP syndrome or severe preeclampsia managed at our perinatal center. The HELLP syndrome was defined by previously published laboratory criteria. Viable pregnancies were divided into 3 groups: HELLP syndrome, partial HELLP syndrome (at least 1, but not all 3, features of the HELLP syndrome), and severe preeclampsia (no features of the HELLP syndrome). Results were compared by means of χ 2 analysis and Student t test where appropriate. Logistic regression was used to evaluate outcome variables at different gestational ages. Results: There were no significant differences in complications among the 3 groups at each gestational age. There was, as expected, a significant decrease in morbidity and mortality rates with advanced gestational age. Conclusions: In severe preeclampsia, neonatal morbidity and death are related to gestational age rather than to the presence or absence of the HELLP syndrome. Whether expectant management is safe for women with the HELLP syndrome requires further study. (Am J Obstet Gynecol 1999;180:221-5.)
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hepatic imaging in hellp syndrome hemolysis elevated liver enzymes and Low Platelet Count
American Journal of Obstetrics and Gynecology, 1996Co-Authors: John R Barton, Bahaeddine M SibaiAbstract:Abstract OBJECTIVES: Our objective was to describe the hepatic imaging findings in selected patients with HELLP syndrome (hemolysis, elevated liver enzymes, and Low Platelet Count) and to correlate these findings with the severity of concurrent clinical and laboratory abnormalities. STUDY DESIGN: Patients with laboratory criteria for HELLP syndrome with complaints of severe right upper quadrant abdominal pain in association with either shoulder pain, neck pain, or relapsing hypotension underwent imaging of the liver. Clinical and laboratory parameters were then correlated with the hepatic imaging findings. RESULTS: Thirty-four patients were evaluated in this study. Computed tomographic scanning of the liver was used for 33 patients. Additional imaging evaluations included magnetic resonance imaging for 4 patients and ultrasonographic evaluation of the liver for 5 patients. In 15 cases (45%) the computed tomographic results were abnormal. The most frequent abnormal hepatic imaging findings were subcapsular hematoma ( n = 13) and intraparenchymal hemorrhage ( n = 6). There was no statistically significant correlation between the presence of an abnormal hepatic imaging finding and the severity of liver function test abnormalities. However, the severity of thrombocytopenia did correlate with hepatic imaging findings ( p = 004). In particular, an abnormal hepatic imaging finding was noted for 10 of 13 patients (77%) with a Platelet Count of ≤ 20 × 10 9 /L ( p = 0012). CONCLUSIONS: Abnormalities in liver function test results do not accurately reflect the presence of abnormal hepatic imaging findings in HELLP syndrome. Patients with HELLP syndrome having complaints of right upper quadrant pain and neck pain, shoulder pain, or relapsing hypotension should undergo imaging of the liver. (Am J Obstet Gynecol 1996;174:1820-7.)
John R Barton - One of the best experts on this subject based on the ideXlab platform.
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subsequent pregnancy outcome in women with a history of hellp syndrome at 28 weeks of gestation
American Journal of Obstetrics and Gynecology, 2003Co-Authors: Mark C Chames, Bassam Haddad, John R Barton, Jeffrey Livingston, Baha M SibaiAbstract:Abstract Objective: The purpose of this study was to describe subsequent pregnancy outcome in women with a history of hemolysis, elevated liver enzymes, and Low Platelet Count syndrome for which delivery occurred at ≤ 28 weeks of gestation during the index pregnancy. Study Design: A descriptive report of women with previous hemolysis, elevated liver enzymes, and Low Platelet Count syndrome who were delivered between August 1984 and July 1998 at the E.H. Crump Women's Hospital (Memphis, Tenn) and between March 1994 and July 1998 at the Central Baptist Hospital (Lexington, Ky). To have adequate time to study subsequent pregnancy outcome, only patients who were delivered >2 years before the analysis were included. Medical records of the index pregnancy and subsequent outcomes were available for review. Results: Adequate folLow-up data were available in 69 patients; the median duration of folLow-up was 5 years (range: 2-14 years). There were 76 subsequent pregnancies among 48 women, of which 62 pregnancies (82%) progressed beyond 20 weeks of gestation. Preeclampsia developed in 34 of 62 subsequent pregnancies (55%). Recurrent hemolysis, elevated liver enzymes, and Low Platelet Count syndrome developed in 4 of these pregnancies (6%), and abruptio placentae developed in 3 of these pregnancies (5%). There were no cases of eclampsia in our population. Delivery before 37 weeks of gestation occurred in 33 of the cases (53%), and 17 of the newborn infants (27%) were small for gestational age ( Conclusion: Patients with a history of hemolysis, elevated liver enzymes, and Low Platelet Count syndrome at ≤ 28 weeks of gestation during the index pregnancy are at increased risk for obstetric complications in subsequent pregnancies. Overall, however, the rate of recurrent hemolysis, elevated liver enzymes, and Low Platelet Count syndrome is only 6%. (Am J Obstet Gynecol 2003;188:1504-8.)
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maternal benefit of corticosteroid therapy in patients with hellp hemolysis elevated liver enzymes and Low Platelet Count syndrome impact on the rate of regional anesthesia
American Journal of Obstetrics and Gynecology, 2002Co-Authors: John M Obrien, Douglas A Milligan, S A Shumate, S L Satchwell, John R BartonAbstract:Abstract OBJECTIVE: Our purpose was to assess the impact of glucocorticoid administration on the rate of regional anesthesia in women with hemolysis, elevated liver enzymes, and Low Platelet Count (HELLP) syndrome. STUDY DESIGN: Maternal records of pregnancies with HELLP syndrome managed between April 1994 and December 1999 were analyzed retrospectively. RESULTS: Sixty-nine patients were identified with antepartum HELLP syndrome and 46 (66%) received glucocorticoids. The presence of thrombocytopenia at admission and the interval from presentation to delivery was evaluated to assess the impact of glucocorticoid use. In the 37 women who had Platelet Counts of 3 , 0 in the untreated group (0 of 11) versus 42% in the steroid group (11 of 26) received regional anesthetic, P =.015. Furthermore, the rate of regional anesthesia increased from 0 in the untreated group delivered within 24 hours (n = 10) to 57% (8 of 14) in the glucocorticoid group, in which women attained a 24-hour latency from presentation to delivery, P =.006. The need for general anesthesia also decreased significantly in treated women who attained a 24-hour latency compared to untreated women who did not, 100% (n = 7) versus 22% (n = 9), P =.003. CONCLUSIONS: Administration of glucocorticoids increases the use of regional anesthesia in women with antepartum HELLP syndrome who have thrombocytopenia, particularly in those who achieve a latency of 24 hours before delivery. (Am J Obstet Gynecol 2002;186:475-9.)
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impact of high dose corticosteroid therapy for patients with hellp hemolysis elevated liver enzymes and Low Platelet Count syndrome
American Journal of Obstetrics and Gynecology, 2000Co-Authors: John M Obrien, Douglas A Milligan, John R BartonAbstract:Abstract Objective: The purpose of this study was to determine whether corticosteroid administration to patients with antepartum HELLP (hemolysis, elevated liver enzymes, and Low Platelet Count) syndrome would alter laboratory values diagnostic for the disease. Study Design: Cases of 37 women with antepartum HELLP syndrome managed between March 1995 and July 1999 were reviewed. Patients were classified on the basis of exposure to corticosteroids and to the dose used. Group 1 did not receive corticosteroids. Group 2 received a standard corticosteroid dosage regimen for promotion of fetal lung maturation. Group 3 received a high-dose corticosteroid regimen of >24 mg/d (most frequently 10 mg dexamethasone as an intravenous bolus dose every 6 hours for 2 doses folLowed by 6 mg as an intravenous bolus dose every 6 hours for 2 to 4 doses). Antepartum changes in laboratory values from diagnosis to delivery were evaluated by means of the Kruskal-Wallis test. Results: Eleven patients did not receive corticosteroids, 15 were given a standard dose, and 11 received high-dose therapy. For each laboratory value assessed (Platelet Count, aspartate aminotransferase activity, and lactate dehydrogenase activity), the corticosteroid groups differed significantly from the no-treatment group (P ≤ .002 for all). A further, significantly greater improvement in Platelet Count was noted between the high-dose group (81%) and the standard-dose group (17%; P = .04). The interval from diagnosis to delivery was also longer for patients treated with the high-dose protocol (51 ± 25 hours) than for both those treated with a standard regimen (26 ± 20 hours) and those who received no treatment (13 ± 11 hours; P
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risk factors for adverse maternal outcomes among women with hellp hemolysis elevated liver enzymes and Low Platelet Count syndrome
American Journal of Obstetrics and Gynecology, 2000Co-Authors: Bassam Haddad, John R Barton, Jeffrey Livingston, Rabih Chahine, Bahaeddine M SibaiAbstract:Abstract Objective: This study was undertake to determine risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and Low Platelet Count) syndrome. Study Design: Maternal medical records of pregnancies complicated by HELLP syndrome managed between July 1, 1992, and April 30, 1999, were reviewed. Risk factors evaluated included maternal age, parity, race, previous preeclampsia, chronic hypertension, gestational age at diagnosis, mean arterial blood pressure, nadir blood Platelet Count ( t test, the χ 2 test, and logistic regression analysis. Results: A total of 183 women with HELLP syndrome were studied. Eclampsia was present in 6%, abruptio placentae was present in 10%, and disseminated intravascular coagulopathy was present in 8%. Forty-one women (22%) required transfusion of blood products. Incidence of eclampsia significantly decreased with increasing gestational age, from 16% at ≤28 weeks' gestation to 3% at >32 weeks' gestation ( P P P P P P 150 U/L, and a peak serum lactate dehydrogenase level of >1400 U/L were not independent risk factors for adverse outcome. Conclusions: Among women with HELLP syndrome, African American race is a risk factor for eclampsia. Both acute renal failure and abruptio placentae are associated with disseminated intravascular coagulopathy. Laboratory parameters of HELLP syndrome are not independent risk factors for adverse maternal outcome. (Am J Obstet Gynecol 2000;183:444-8.)
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hepatic imaging in hellp syndrome hemolysis elevated liver enzymes and Low Platelet Count
American Journal of Obstetrics and Gynecology, 1996Co-Authors: John R Barton, Bahaeddine M SibaiAbstract:Abstract OBJECTIVES: Our objective was to describe the hepatic imaging findings in selected patients with HELLP syndrome (hemolysis, elevated liver enzymes, and Low Platelet Count) and to correlate these findings with the severity of concurrent clinical and laboratory abnormalities. STUDY DESIGN: Patients with laboratory criteria for HELLP syndrome with complaints of severe right upper quadrant abdominal pain in association with either shoulder pain, neck pain, or relapsing hypotension underwent imaging of the liver. Clinical and laboratory parameters were then correlated with the hepatic imaging findings. RESULTS: Thirty-four patients were evaluated in this study. Computed tomographic scanning of the liver was used for 33 patients. Additional imaging evaluations included magnetic resonance imaging for 4 patients and ultrasonographic evaluation of the liver for 5 patients. In 15 cases (45%) the computed tomographic results were abnormal. The most frequent abnormal hepatic imaging findings were subcapsular hematoma ( n = 13) and intraparenchymal hemorrhage ( n = 6). There was no statistically significant correlation between the presence of an abnormal hepatic imaging finding and the severity of liver function test abnormalities. However, the severity of thrombocytopenia did correlate with hepatic imaging findings ( p = 004). In particular, an abnormal hepatic imaging finding was noted for 10 of 13 patients (77%) with a Platelet Count of ≤ 20 × 10 9 /L ( p = 0012). CONCLUSIONS: Abnormalities in liver function test results do not accurately reflect the presence of abnormal hepatic imaging findings in HELLP syndrome. Patients with HELLP syndrome having complaints of right upper quadrant pain and neck pain, shoulder pain, or relapsing hypotension should undergo imaging of the liver. (Am J Obstet Gynecol 1996;174:1820-7.)
Alexandre Boyer - One of the best experts on this subject based on the ideXlab platform.
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Platelet transfusion and catheter insertion for plasma exchange in patients with thrombotic thrombocytopenic purpura and a Low Platelet Count
Transfusion, 2015Co-Authors: Etienne Riviere, Melanie Saintleger, Chloe James, Yahsou Delmas, Benjamin Clouzeau, Nam Bui, Anne Vital, Paul Coppo, Didier Gruson, Alexandre BoyerAbstract:BACKGROUND In thrombotic thrombocytopenic purpura (TTP), Platelet (PLT) transfusion is contraindicated unless a life-threatening hemorrhage occurs. However, when PLT Count is Low (<20 × 109/L), their benefit–risk balance before central venous catheter (CVC) insertion for plasma exchange (PE) has not specifically been addressed in guidelines. CASE REPORTS We report two cases in which PLTs were transfused before CVC insertion for PE, resulting in fatal myocardial infarction or neurologic complications. DISCUSSION To date, there is a paucity of high-quality, evidence-based information on prophylactic PLT transfusion for CVC placement in TTP. Several monocenter series report that CVC could be inserted safely without PLT transfusion by experienced teams under ultrasound guidance. Uncertainty makes most physicians uncomfortable with this decision and this is a common reason why PLT transfusion remains a “precautionary” albeit misguided position. CONCLUSION We propose a practical algorithm to avoid unnecessary PLT transfusion before CVC insertion for rapid PE in the initial management of TTP patients. We recommend no prophylactic PLT transfusion but CVC insertion in a compressible vein under ultrasound guidance by an experienced team or quick PE started on two peripheral veins if possible. PLTs should only be transfused in case of severe bleeding in association with plasma infusion and CVC insertion for immediate PE.
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Platelet transfusion and catheter insertion for plasma exchange in patients with thrombotic thrombocytopenic purpura and a Low Platelet Count
Transfusion, 2015Co-Authors: Etienne Riviere, Chloe James, Yahsou Delmas, Benjamin Clouzeau, Nam Bui, Anne Vital, Paul Coppo, Didier Gruson, A. Saint-lezer, Alexandre BoyerAbstract:BACKGROUND: In thrombotic thrombocytopenic purpura (TTP), Platelet (PLT) transfusion is contraindicated unless a life-threatening hemorrhage occurs. However, when PLT Count is Low (\textless20 × 10(9) /L), their benefit-risk balance before central venous catheter (CVC) insertion for plasma exchange (PE) has not specifically been addressed in guidelines. CASE REPORTS: We report two cases in which PLTs were transfused before CVC insertion for PE, resulting in fatal myocardial infarction or neurologic complications. DISCUSSION: To date, there is a paucity of high-quality, evidence-based information on prophylactic PLT transfusion for CVC placement in TTP. Several monocenter series report that CVC could be inserted safely without PLT transfusion by experienced teams under ultrasound guidance. Uncertainty makes most physicians uncomfortable with this decision and this is a common reason why PLT transfusion remains a "precautionary" albeit misguided position. CONCLUSION: We propose a practical algorithm to avoid unnecessary PLT transfusion before CVC insertion for rapid PE in the initial management of TTP patients. We recommend no prophylactic PLT transfusion but CVC insertion in a compressible vein under ultrasound guidance by an experienced team or quick PE started on two peripheral veins if possible. PLTs should only be transfused in case of severe bleeding in association with plasma infusion and CVC insertion for immediate PE.
James N Martin - One of the best experts on this subject based on the ideXlab platform.
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a prospective randomized trial comparing the efficacy of dexamethasone and betamethasone for the treatment of antepartum hellp hemolysis elevated liver enzymes and Low Platelet Count syndrome
American Journal of Obstetrics and Gynecology, 2001Co-Authors: Christy M Isler, Everett F Magann, Scott P Barrilleaux, David J Bass, James N MartinAbstract:Abstract Objective: This study was undertaken to determine whether dexamethasone or betamethasone is superior for the antepartum treatment of HELLP (hemolysis, elevated liver enzymes, and Low Platelet Count) syndrome. Study Design: This prospective, randomized, clinical investigation compared intravenously administered dexamethasone and intramuscularly administered betamethasone in the treatment of gravid women with HELLP syndrome. Efficacy end points included laboratory values (Platelet Count, lactate dehydrogenase activity, aspartate aminotransferase activity) and clinical parameters (mean arterial pressure, urinary output). Results: Forty patients were enrolled in the study, 19 in the dexamethasone arm and 21 in the betamethasone arm. The adjusted time-averaged changes from baseline were significant for aspartate aminotransferase activity (dexamethasone, –20.4 ± 9.6 U/L; betamethasone, 9.9 ± 8.9 U/L; P = .029), mean arterial pressure (dexamethasone, –15.6 ± 1.4 mm Hg; betamethasone, –8.1 ± 1.4 mm Hg; P P = .043). Conclusion: Intravenously administered dexamethasone appears to be more effective than intramuscularly adminstered betamethasone for the antepartum treatment of mothers with HELLP syndrome. (Am J Obstet Gynecol 2001;184:1332-9.)
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the spectrum of severe preeclampsia comparative analysis by hellp hemolysis elevated liver enzyme levels and Low Platelet Count syndrome classification
American Journal of Obstetrics and Gynecology, 1999Co-Authors: James N Martin, Brian K Rinehart, Warren L May, Everett F Magann, Dom A Terrone, Pamela G BlakeAbstract:Abstract 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. (Am J Obstet Gynecol 1999;180:1373-84.)
K S Joseph - One of the best experts on this subject based on the ideXlab platform.
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incidence and risk factors for severe preeclampsia hemolysis elevated liver enzymes and Low Platelet Count syndrome and eclampsia at preterm and term gestation a population based study
American Journal of Obstetrics and Gynecology, 2021Co-Authors: Sarka Lisonkova, Jeffrey N Bone, Giulia M Muraca, Neda Razaz, Li Qing Wang, Yasser Sabr, Amelie Boutin, C Mayer, K S JosephAbstract:Background The majority of previous studies on severe preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, and Low Platelet Count syndrome were hospital-based or included a relatively small number of women. Large, population-based studies examining gestational age–specific incidence patterns and risk factors for these severe pregnancy complications are lacking. Objective This study aimed to assess the gestational age–specific incidence rates and risk factors for severe preeclampsia, hemolysis, elevated liver enzymes, and Low Platelet Count syndrome, and eclampsia. Study Design We carried out a retrospective, population-based cohort study that included all women with a singleton hospital birth in Canada (excluding Quebec) from 2012 to 2016 (N=1,078,323). Data on the primary outcomes (ie, severe preeclampsia, hemolysis, elevated liver enzymes, and Low Platelet Count syndrome, and eclampsia) were obtained from delivery hospitalization records abstracted by the Canadian Institute for Health Information. A Cox regression was used to assess independent risk factors (eg, maternal age and chronic comorbidity) for each primary outcome and to assess differences in the effects at preterm vs term gestation ( Results The rates of severe preeclampsia (n=2533), hemolysis, elevated liver enzymes, and Low Platelet Count syndrome (n=2663), and eclampsia (n=465) were 2.35, 2.47, and 0.43 per 1000 singleton pregnancies, respectively. The cumulative incidence of term-onset severe preeclampsia was Lower than that of preterm-onset severe preeclampsia (0.87 vs 1.54 per 1000; rate ratio, 0.57; 95% confidence intervals, 0.53–0.62), the rates of hemolysis, elevated liver enzymes, and Low Platelet Count syndrome were similar (1.32 vs 1.23 per 1000; rate ratio, 0.93; 95% confidence interval, 0.86–1.00), and the preterm-onset eclampsia rate was Lower than the term-onset rate (0.12 vs 0.33 per 1000; rate ratio, 2.64; 95% confidence interval, 2.16–3.23). For each primary outcome, chronic comorbidity and congenital anomalies were stronger risk factors for preterm- vs term-onset disease. Younger mothers (aged Conclusion The risk for severe preeclampsia declined at term, eclampsia risk increased at term, and hemolysis, elevated liver enzymes, and Low Platelet Count syndrome risk was similar for preterm and term gestation. Young maternal age was associated with an increased risk for eclampsia and term-onset severe preeclampsia. Prepregnancy comorbidity and fetal congenital anomalies were more strongly associated with severe preeclampsia, hemolysis, elevated liver enzymes, and Low Platelet Count syndrome, and eclampsia at preterm gestation.
