Abstract

The syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP Syndrome) in preeclampsia is a severe complication of the disease process with a high cesarean section (CS) rate. This report describes the authors' experience with general and epidural anesthesia in patients with severe preeclampsia and HELLP syndrome undergoing CS. Of 47 patients who underwent CS, 31 received general anesthesia (GA group) and 16 received lumbar epidural anesthesia (LEA group). One of the two maternal deaths that occurred in the GA group was associated with difficult intubation that was partly due to the presence of severe laryngeal edema. In the LEA group, no major maternal complications occurred other than transient hypotension in six patients during induction. There were significant changes in the platelet count in both groups. In the LEA group the platelet count decreased from 131 ± 44 to 71 ± 24 (×10³/mm³) ( p < 0.006) in the postpartum period and in the GA group it decreased from 90 ± 40 to 54 ± 23 (×10³/mm³) ( p < 0.008) with mean platelet counts of less than 100 (×10³/mm³) in both groups. In the GA group, the infant birth weights and 1- and 5-minute Apgar scores were significantly lower ( p < 0.03 and p < 0.004, respectively) and the number of babies with Apgar scores less than 7 at 5 minutes were significantly higher ( p < 0.01) compared with the LEA group. The number of neonates with platelet counts less than 150 (×10³/mm³) were similar in both groups. The poor perinatal outcome is probably related to the severity of the maternal disease process rather than the choice of anesthetic technique. The occurrence of rapid deterioration of platelet count requires close monitoring by serial determinations of platelet counts during the course of anesthetic management.