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HELLP syndrome: CT evaluation.

Patients with the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) require careful observation and expedient delivery. However, those who develop this syndrome peripartum do not always fulfill its diagnostic criteria before labor begins. We investigated the potential usefulness of liver and spleen CT evaluation in identifying such patients. Seven patients with this syndrome were studied by CT scanning on postpartum days 0-3 and again 3-4 weeks after delivery. Although 3 patients with severe thrombocytopenia had a reduced liver-spleen CT number ratio (< 1.1) and subsequent normalization, the remaining 4 with less severe thrombocytopenia demonstrated no CT changes. Thus, antepartum evaluation of liver and spleen by CT may not be sensitive enough to detect patients who develop HELLP syndrome during the peripartum period. Serial examination of platelet counts may be more useful than CT in detecting patients at risk for this peripartum syndrome.