Objective To describe the current management and outcomes of HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome in the UK.

Methods A national descriptive study using the UK Obstetric Surveillance System, including all women diagnosed with HELLP syndrome between June 2011 and May 2012.

Results 109 women were identified with HELLP syndrome. 69 women (63%) were diagnosed with HELLP syndrome antenatally at a median gestation of 35 weeks (range 21–41). 54% (37/68) of antenatally diagnosed women had a planned management of immediate delivery and delivered a median of 3 h 37 min after diagnosis (range 53 min–21 h 26 min); 43% (29/68) had a planned management of delivery within 48 h and delivered a median of 11 h 40 min after diagnosis (range 1 h 28 min–74 h 43 min); only 2/68 had a planned attempt at expectant management, with one delivering 3 days and the other 12 days after diagnosis. Overall, 41% (45/109) of women received corticosteroids (only three for maternal indications, two of whom were diagnosed postpartum), 78% (84/108) received antihypertensive medication and 78% (85/109) were given magnesium sulphate. Severe morbidity was noted in 15% (16/109) of the women and one woman died (case fatality 0.9%, 95%CI 0.02–5.0%). Major complications were reported in 9% (10/108) of infants and there were two perinatal deaths (perinatal mortality rate 18 per 1,000 total births, 95%CI 2–62). All cases associated with major maternal or perinatal complication occurred in women delivered within 48 h of diagnosis or in women diagnosed postpartum.

Conclusions HELLP syndrome is associated with severe maternal and perinatal morbidity. Expectant management is rarely used in the UK.