Preeclampsia associated with hemolysis, elevated liver enzymes, and low platelets--an obstetric emergency?

A study was undertaken of 27 patients with severe preeclampsia who had hemolysis, liver enzyme elevation, and thrombocytopenia as described by Weinstein. In addition to this triad, all patients exhibited the symptoms and signs of pregnancy-induced hypertension by which the diagnosis is usually established. These patients were admitted to the hospital for strict bed rest. Patients who showed evidence of rapid maternal or fetal deterioration were delivered promptly. The remainder were managed without immediate delivery and with the institution of magnesium sulfate to prevent eclamptic seizures. Patients were monitored closely, and amniocentesis was performed to ascertain fetal lung status. If the lungs were mature, the infant was delivered. Attempting to delay delivery until a lecithin: sphingomyelin (L:S) ratio was mature resulted in only two infants developing respiratory distress syndrome (RDS); both had L:S ratios of less than 1.5 and were delivered for maternal indications. Maternal condition rapidly improved within 72 hours of delivery, and there was no persistence of thrombocytopenia or elevation of liver enzymes. Immediate delivery of preeclamptic patients who have thrombocytopenia and elevated liver enzymes may not be warranted. These findings suggest that the syndrome of hemolysis, elevated liver enzymes, and low platelets is not a separate entity, but merely a cluster of signs seen in some patients with hypertensive disorders in pregnancy.