The utility of umbilical artery Doppler investigation in women with the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.

Abstract

Our aim was to study the utility of umbilical artery Doppler velocimetry in the management of women with the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Fetuses of women with the HELLP syndrome underwent ultrasonographic evaluation at initial presentation. An abnormal umbilical artery Doppler study was defined as a systolic/diastolic ratio >5.0. The systolic/diastolic ratios were correlated with outcome variables including laboratory findings, latency, mode of delivery, and birth weight. Fifty women were enrolled into the study. Eighteen of the fetuses (36%) had abnormal waveforms, with 8 fetuses demonstrating either absent or reversed end-diastolic umbilical artery blood flow. The mean umbilical artery systolic/diastolic ratio was significantly higher for fetuses with intrauterine growth restriction or who were small for gestational age than for those without these diagnoses (P =.001, for each). No correlation was observed between the systolic/diastolic ratio and the laboratory findings at admission, the degree of hypertension at admission, or the latency to delivery (all, P >.05). No woman with a fetus at a viable gestational age having abnormal Doppler waveforms had a successful vaginal delivery. Abnormal umbilical artery Doppler velocimetry is associated with a higher risk of fetal growth restriction and a high likelihood of cesarean delivery. These values were not correlated with the severity of maternal disease.