LAUSR

BACKGROUND The characteristics of antiphospholipid syndrome (APS)-associated HELLP syndrome are poorly described, likely due to the low frequency of this combination of syndromes. OBJECTIVE To compare the characteristics and prognosis of HELLP syndrome in patients with and patients without APS. STUDY DESIGN In this multicentric case-control study, adult women diagnosed with HELLP syndrome before 34 weeks' gestation, and who were also tested for antiphospholipid antibodies according to international diagnostic recommendations, were included. Cases ("HELLP-APS+") were defined as patients who fulfilled the international classification criteria for APS syndrome; they were retrospectively recruited by screening the 672 APS patients in our APS database; Controls ("HELLP-APS-") were defined as patients who did not fulfill APS criteria; they were retrospectively recruited from our hospital admission database. RESULTS Overall, 71 patients were included (mean age, 30±5 years), 23 patients in the HELLP-APS+ group and 48 patients in the HELLP-APS- group. The live birth rate was significantly lower for HELLP-APS+ patients compared to HELLP-APS- patients (43.5% versus 89.4%; P<0.001). The HELLP-APS+ patients gave birth prematurely more often than the HELLP-APS- patients: 24 weeks' gestation (22.0-28.0) versus 30 weeks' gestation (27.0-33.0) (P<0.001). Among HELLP-APS+ patients, 39% required an induced abortion due to HELLP syndrome severity versus 8.5% of HELLP-APS- patients (P=0.006). The intensive care unit admission rate was 61.9% in HELLP-APS+ patients, which was significantly higher than the 27.7% rate in HELLP-APS- patients (P=0.007). No mother died. CONCLUSION Our results suggest that presence of APS is a poor prognostic factor for HELLP syndrome, for both the mother and fetus.