Matchaba Patrice T, Moodley Jagidesa
Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936-1080, USA.
Cochrane Database Syst Rev. 2009 Jul 8;2009(3):CD002076. doi: 10.1002/14651858.CD002076.pub3.
Hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is a severe form of pre-eclampsia. Pre-eclampsia is a multi-system disease of pregnancy associated with an increase in blood pressure and increased perinatal and maternal morbidity and mortality. Eighty per cent of women with HELLP syndrome present before term. There are suggestions from observational studies that steroid treatment in HELLP syndrome may improve disordered maternal hematological and biochemical features and perhaps perinatal mortality and morbidity.
To summarise the evidence on the effects of corticosteroids on maternal and neonatal mortality and morbidity in women with HELLP syndrome.
We searched the Cochrane Pregnancy and Childbirth Group trials register (October 2003). We scanned lists of references from review articles and primary studies.
Randomised and quasi-randomised trials evaluating the effects of adjunctive corticosteroids in patients diagnosed with HELLP syndrome were sought.
The two authors independently applied inclusion criteria, assessed trial quality and extracted relevant data.
Of the five studies reviewed (n = 170), three were conducted antepartum and two postpartum. Four of the studies randomised participants to standard therapy or dexamethasone. One study compared dexamethasone with betamethasone. Dexamethasone versus control There were no significant differences in the primary outcomes of maternal mortality and morbidity due to placental abruption, pulmonary oedema and liver hematoma or rupture. Of the secondary maternal outcomes, there was a tendency to a greater platelet count increase over 48 hours, statistically significantly less mean number of hospital stay days (weighted mean difference (WMD) -4.50, 95% confidence interval (CI) -7.13 to -1.87), mean interval (hours) to delivery (41 +/- 15) versus (15 +/- 4.5) (p = 0.0068) in favour of women allocated to dexamethasone.There were no significant differences in perinatal mortality or morbidity due to respiratory distress syndrome, need for ventilatory support, intracerebral hemorrhage, necrotizing enterocolitis and a five minute Apgar less than seven. The mean birthweight was significantly greater in the group allocated to dexamethasone (WMD 247.00, 95% CI 65.41 to 428.59).Dexamethasone versus betamethasone There were no significant differences in all the maternal and perinatal mortality and in primary morbidity outcomes.Women randomised to dexamethasone fared significantly better for: oliguria, mean arterial pressure, mean increase in platelet count, mean increase in urinary output and liver enzyme elevations.
AUTHORS' CONCLUSIONS: There is insufficient evidence to determine whether adjunctive steroid use in HELLP syndrome decreases maternal and perinatal mortality, major maternal and perinatal morbidity.
溶血、肝酶升高和血小板减少（HELLP）综合征是子痫前期的一种严重形式。子痫前期是一种妊娠多系统疾病，与血压升高以及围产期和孕产妇发病率及死亡率增加有关。80%的HELLP综合征女性在足月前发病。观察性研究表明，HELLP综合征的类固醇治疗可能改善孕产妇血液学和生化异常，或许还能降低围产期死亡率和发病率。
总结皮质类固醇对HELLP综合征女性孕产妇和新生儿死亡率及发病率影响的证据。
我们检索了Cochrane妊娠与分娩组试验注册库（2003年10月）。我们浏览了综述文章和原始研究的参考文献列表。
寻找评估辅助皮质类固醇对诊断为HELLP综合征患者影响的随机和半随机试验。
两位作者独立应用纳入标准、评估试验质量并提取相关数据。
在所综述的5项研究（n = 170）中，3项在产前进行，2项在产后进行。4项研究将参与者随机分为标准治疗组或地塞米松组。1项研究比较了地塞米松与倍他米松。地塞米松与对照组：在孕产妇死亡率以及胎盘早剥、肺水肿和肝血肿或破裂导致的孕产妇发病率这些主要结局方面，没有显著差异。在孕产妇次要结局方面，48小时内血小板计数有增加更多的趋势，住院天数的平均数量在统计学上显著更少（加权平均差（WMD）-4.50，95%置信区间（CI）-7.13至-1.87），分娩的平均间隔时间（小时）为（41±15）对比（15±4.5）（p = 0.0068），这有利于分配到地塞米松组的女性。在因呼吸窘迫综合征、通气支持需求、脑出血、坏死性小肠结肠炎和5分钟阿氏评分低于7分导致的围产期死亡率或发病率方面，没有显著差异。分配到地塞米松组的婴儿平均出生体重显著更高（WMD 247.00，95%CI 65.41至428.59）。地塞米松与倍他米松：在所有孕产妇和围产期死亡率以及主要发病率结局方面，没有显著差异。随机分配到地塞米松组的女性在少尿、平均动脉压、血小板计数平均增加、尿量平均增加和肝酶升高方面表现明显更好。
没有足够证据确定HELLP综合征中使用辅助类固醇是否能降低孕产妇和围产期死亡率、主要孕产妇和围产期发病率。
