Regional Anaesthesia for Primary Caesarean Section in Patients with HELLP Syndrome

摘要

HELLP (Hemolysis, Elevated Liver enzymes, Low platelets) syndrome is often considered a contraindication for regional anaesthesia. We wanted to determine the feasibility and the safety of regional anaesthetic techniques for primary caesarean section in case of preterm HELLP syndrome .A retrospective study was performed in a tertiary care centre including all patients who underwent primary caesarean section for HELLP syndrome. A total number of 102 charts were reviewed. Mean gestational age was 30.6 weeks (SD 2.7, range 23-36 weeks). There were 7 (6.9 %) patients with postpartum HELLP and 95 with antepartum HELLP. In case of antepartum HELLP in 37 (36.3 %) general anaesthesia was selected; in 53 (52.0 %) combined spinal epidural anaesthesia was performed and 12 (11,8 %) women received single dose spinal anaesthesia. Preoperatively thrombocyte count was significantly higher (p<0.01) in the combined spinal epidural group (113.000/mm~3) while there was no difference (p=0.6) when general (88.000/mm~3) and spinal anesthesia alone (95.000/mm3) were compared.. Our data demonstrate that regional anaesthesia is feasible and safe in HELLP syndrome. It should be kept in mind that there is more than thrombocyte count alone in the selection of the best technique. When time permits platelets can be transfused in borderline cases.