Comparison of general clinical data of pregnant women with HELLP in the respective group
A total of 106 pregnant women with HELLP were recruited in this study. The 24-hUPro levels ranged from 0.1 to 21.3 g, with 27 cases (25.47%, 27/106) in the non-proteinuric group and 79 cases (74.53% ,79/106) in the proteinuric group. Moreover, in the proteinuric group, there were 33 cases in the mild group, 21 cases in moderate group and 25 cases in the severe group (Table 1).
Compared with proteinuric group, the non-albuminuric group HELLP pregnant women's diagnosis and delivery gestational week is later (p < 0.05 respectively). No significant differences were identified in age, BMI before pregnancy, the proportion of twins, pre‑eclampsia/eclampsia, blood pressure, headache and nausea, vomiting, abdominal pain, skin jaundice, blurred vision, edema between the two groups (p > 0.05 respectively).
Significant differences were identified in gestational age at diagnosis, gestational age at termination of pregnancy, history of hypertension, SBP, DBP (p < 0.05). The incidences of abdominal pain, skin jaundice, headache, blurred vision, edema in severe HELLP group were significantly higher than those in mild and moderate HELLP groups (p < 0.05), no significant difference was identified in other symptoms between the subgroups (p > 0.05) (Table 1) .
Comparison of the results of HELLP pregnant women's laboratory indexes
Compared with the non-albuminuric group, the HELLP pregnant women of the proteinuric group has the higher levels of ALT, AST, ALB, LDH, PLT, FIB, APTT, and proportions of tubular urine (p < 0.05 respectively); Of note, the differences in the above indicators were also statistically significant in the three subgroups of the proteinuric group (p < 0.05 respectively), that is, with increasing urinary protein levels of HELLP pregnant women, ALT, AST, LDH, PLT, FIB, APTT, proportions of tubular urine tend to increase, while ALB tends to do the opposite. At the same time, other laboratory indexes such as TBil, DBil, ALP, γ-GGT, TBA, WBC, Hb, INR, BUN, SCr, UA were not significantly different between the non-albuminuric group and the albuminuric group, and the three subgroups of the albuminuric group (p > 0.05 respectively). As indicated by the above results, hemolysis, liver enzymes and thrombocytopenia occurred in HELLP patients with the increase of proteinuric, consistent with the typical symptoms of HELLP patients. There was a significant difference in PT level among the three subgroups (p = 0.015) , but no significant difference was found in the comparison between the albuminuric group and the non-albuminuric group (p = 0.363) (Table 2).
Comparison of the complications and pregnancy outcome of HELLP pregnant women in the different groups
In the non-proteinuria group, 2 case (7.41%) had placental abruption, 5 cases (18.52%) had fetal growth restriction. There was no significant difference in total length of stay, proportion of ICU stay, length of ICU stay, the incidence of severe complications during pregnancy and delivery, cesarean section, abnormal blood pressure and maternal mortality between the non-proteinuric group and the proteinuric group (p > 0.05 respectively)(Table 3).
In the three subgroups of the proteinuric group, the ratio of fetal growth restriction, cesarean section and postpartum hemorrhage were compared, and the difference was statistically significant (p < 0.05 respectively). The incidences of placental abruption, fetal death in utero and maternal mortality were increased with the increase of urinary protein level, but there was no significant difference because of the lower incidences (p > 0.05 respectively). No significant differences were identified in total length of stay, proportion of ICU stay, length of ICU stay, the incidence of severe complications during pregnancy and delivery such as DIC, coagulopathy, acute liver failure, acute renal failure, pulmonary edema and blood pressure at 42 days after delivery between the three subgroups (p > 0.05 respectively) (Table 3).
In this study, 1 case (0.94% , 1/106) of pregnant women with HELLP died. The pregnant women had no chronic disease history and did not have regular antenatal check-up during pregnancy. At the 38th week of pregnancy, the case had extremely elevated blood pressure (260/120 mmHg), chest tightness and wheezing, dizziness, headache, blindness, light perception only, fundus hemorrhage, no significant abnormalities in liver and kidney function and immune indexes. After admission, there was 1 case of live birth by emergency section through comprehensive evaluation and multi-disciplinary cooperation in diagnosis and treatment. Although the patient's condition was significantly relieved, the fluctuation of blood pressure was (130-160) /(80-100) mmHg. The case had intermittent fever and unrelieved blindness, deep coma and no spontaneous breathing. The imaging results showed intracranial hemorrhage, which was broken into the hypothalamus. The family gave up further treatment.
Comparison of adverse neonatal outcomes in pregnant women with HELLP
Compared with the proteinuric group, the non-proteinuric group had higher birth weight, birth length, and lower SGA, admission rate in NICU (p < 0.05). The incidences of other complications and adverse outcomes (e.g., neonatal infection, neonatal jaundice, and neonatal anemia) in the non-albuminuric group were lower than those in the albuminuric group, and the differences also achieved statistical significance (p < 0.05 respectively) (Table 4).
In the three subgroups of the proteinuric group, significant differences were identified in the adverse outcomes of newborns (p < 0.05), and the incidence of adverse outcomes in neonates tended to be higher. Significant differences were identified in birth weight, birth length, and lower SGA and NICU occupancy rate among the three subgroups (p < 0.05) (Table 4).