Original
Prognosis
Patients who have had HELLP syndrome should be counseled that they have a 19 to 27 percent risk of developing the syndrome in subsequent pregnancies.They also have up to a 43 percent risk of developing preeclampsia in another pregnancy.Patients with class I HELLP syndrome have the highest risk of recurrence.When the syndrome recurs, it tends to develop later in gestation and is generally less severe after two episodes. Patients who have had HELLP syndrome may subsequently use oral contraceptive pills safely.Patients who develop atypical early-onset preeclampsia or HELLP syndrome should be screened for the presence of antiphospholipid antibodies.
Much controversy surrounds the use of acetylsalicylic acid (aspirin) or calcium to prevent preeclampsia. To date, neither calcium nor aspirin has been specifically studied in patients with HELLP syndrome. Although one study suggested that aspirin therapy might be helpful in selected patients with early-onset severe preeclampsia, a large, double-blind, randomized, controlled trial failed to demonstrate benefit for this approach. In this recently released large study, aspirin therapy did not reduce the incidence of preeclampsia or improve perinatal outcomes in pregnant women at high risk for this complication of pregnancy. Likewise, several studies suggested that calcium might be useful in preventing preeclampsia in high-risk patients.Yet a recent large, multicenter study found that calcium supplementation during pregnancy did not prevent preeclampsia or adverse perinatal outcomes