# Maternal Morbidity and Complications in Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) Syndrome: A Retrospective Case Series

## TL;DR

This study examines maternal complications from HELLP syndrome in Afghanistan, highlighting high mortality and the need for better care.

## Contribution

First detailed epidemiological profile of HELLP syndrome in a conflict-affected, low-resource setting like Afghanistan.

## Key findings

- HELLP syndrome incidence was 0.09% of all obstetric admissions.
- Severe complications included disseminated intravascular coagulation and subcapsular liver hematoma.
- Maternal mortality rate was 7.7%, with most patients recovering.

## Abstract

Background

HELLP syndrome (Hemolysis, Elevated Liver Enzymes, and Low Platelets) is a severe obstetric complication associated with significant maternal morbidity and mortality. While its epidemiology is well-described in high-resource settings, data from conflict-affected and resource-limited regions like Afghanistan are critically scarce. This study aimed to delineate the incidence, risk profiles, complications, and outcomes of HELLP syndrome at a major tertiary healthcare hospital.

Methodology

A retrospective, descriptive case series was conducted at Rabia Balkhi Hospital in Kabul, reviewing all obstetric admissions from January 1 to December 31, 2022. Among 29,633 admissions, 26 patients met the inclusion criteria for HELLP syndrome based on established laboratory parameters (LDH >600 U/L, AST >70 U/L, platelets <100,000/mm³). Data on demographics, clinical presentation, risk factors, complications, and maternal outcomes were extracted and analyzed using descriptive statistics.

Results

The incidence of HELLP syndrome was 26 cases (0.09%) of all obstetric admissions. The most prevalent risk factors were abruptio placentae (10, 38.5%), diabetes mellitus (5, 19.2%), and chronic hypertension (4, 15.4%). Major maternal complications included disseminated intravascular coagulation (5, 19.2%), renal failure (4, 15.4%), and pulmonary edema (3, 11.5%). Notably, subcapsular liver hematoma, a rare but often fatal complication, was present in two cases (7.7%). The maternal mortality rate was 7.7% (n = 2), with a 92.3% recovery rate among survivors.

Conclusions

This study provides the first detailed epidemiological profile of HELLP syndrome. While the incidence aligns with some regional reports, the high prevalence of severe complications and a substantially elevated maternal mortality rate highlight critical systemic challenges. These findings underscore the urgent need for enhanced antenatal screening, early diagnosis, and improved access to critical care resources, including platelet transfusions and emergency surgical intervention, to mitigate preventable deaths in low-resource settings.