ABSTRACT
The syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome)
and of acute fatty liver of pregnancy (AFLP) do not have an abrupt onset. Thrombocytopenia
or reduced antithrombin activity, or both, seen at presentation do not result from
these complications. There are a small number of pregnant women who exhibit a gradual
antenatal decline in platelet counts or antithrombin activity, or both, irrespective
of the presence or absence of preeclampsia. Those who develop a profound decrease
in either platelet counts or antithrombin activity are at an increased risk for developing
perinatal aspartate aminotransferase (AST) elevation. Thrombocytopenia or reduced
antithrombin activity, or both, precede the onset of these diseases. Therefore, monitoring
of platelet counts and antithrombin activity during pregnancy is clinically useful
for identifying women at an increased risk of the HELLP syndrome and AFLP. Because
women with twin pregnancies are likely to exhibit a decrease in platelet counts or
antithrombin activity, or both, compared with women with singleton pregnancies, HELLP
syndrome and AFLP are more likely to occur in women with twin pregnancies.
KEYWORD
Gestational thrombocytopenia - liver dysfunction - pregnancy-induced antithrombin
deficiency
