Erdemoğlu M, Kuyumcuoğlu U, Kale A, Akdeniz N
Department of Obstetrics and Gynecology, Dicle University Medical School, Diyarbakir, Turkey.
Clin Exp Obstet Gynecol. 2010;37(3):213-6.
To ascertain the characteristics, clinical features, and maternal fetal outcome in HELLP (hemolysis elevated liver enzymes, low platelets) syndrome at a tertiary referral center.
This was a cross-sectional study carried out at Dicle University between January 2004 and December 2008 in which the charts of 126 cases were retrieved retrospectively and data analyzed descriptively.
Of all deliveries 0.9% were complicated by HELLP syndrome. Of the cases with HELLP syndrome 79 (62.6%) had preeclampsia, 28 (22.2%) had eclampsia and 19 (15.2%) had a diagnosis of HELLP syndrome. The values of significant biochemical parameters (mean +/- SD) were documented as ALT (alanin aminotransferase) 224 +/- 42 IU/I and ALT1 (after birth) 140 +/- 22, AST 379 +/- 23 IU/l and AST1 215 +/- 51, LDH (lactate dehydrogenase) 1418 +/- 67 IU/l and LDH1 875 +/- 16, together with the hematological parameters as platelet count (86 +/- 12 K/Ul), urine protein (3 + in urine test stick) and albumin levels (2 + 0.9 g/dl). Eighty-six (68.25%) of the patients required albumin replacement. Thirty-one (24.6%) cases were nullipara and 95 (75.4%) multipara; of which 32 women (25.4%) were in Class I, and 94 (74.6 %) in Class II of complete HELLP syndrome. Regular antenatal examination was accomplished in a very small number of patients (12.25%). Fifty-eight (46.03%) patients required transfusions with blood or blood products and 12 (9.5%) underwent laparotomy due to major intraabdominal bleeding. Magnesium sulphate to prevent convulsions and corticosteroids (12 mg betametazone) to enhance fetal lung maturity were administered. Forty-four (34.9%) cases had vaginal delivery and 82 (65.1%) cesarean section; another 18 (14.2%) were with in utero stillbirth. Fifteen babies (11.9%) died, 26 (20.63%) developed placental abruption, 14 (11.11%) acute renal insufficiency, and 13 (10.31%) postoperative subcutaneous hematomas. Maternal mortality occurred in ten cases (7.93%).
HELLP syndrome is a pathology associated with a high incidence of maternal and perinatal complications. Laboratory parameters in cases with HELLP syndrome are not efficient in detecting perinatal results, but can be used as risk denominators in evaluating maternal complications. Therefore, for patients with HELLP syndrome, standard antenatal follow-up protocols should be applied in order to obtain early diagnosis and improve the speed of transfer to obstetric departments with expertise in this field.
在一家三级转诊中心确定HELLP（溶血、肝酶升高、血小板减少）综合征的特征、临床特点及母婴结局。
这是一项于2004年1月至2008年12月在狄克莱大学开展的横断面研究，回顾性检索了126例患者的病历并进行描述性数据分析。
所有分娩中0.9%并发HELLP综合征。在HELLP综合征病例中，79例（62.6%）患有先兆子痫，28例（22.2%）患有子痫，19例（15.2%）诊断为HELLP综合征。记录的重要生化参数值（均值±标准差）为谷丙转氨酶（ALT）224±42 IU/I及出生后ALT1 140±22，谷草转氨酶（AST）379±23 IU/l及AST1 215±51，乳酸脱氢酶（LDH）1418±67 IU/l及LDH1 875±16，血液学参数为血小板计数（86±12 K/μl）、尿蛋白（尿试纸检测为3 +）及白蛋白水平（2 + 0.9 g/dl）。86例（68.25%）患者需要补充白蛋白。31例（24.6%）为初产妇，95例（75.4%）为经产妇；其中32例（25.4%）为完全性HELLP综合征I级，94例（74.6%）为II级。极少数患者（12.25%）进行了规律的产前检查。58例（46.03%）患者需要输血或血液制品，12例（9.5%）因腹腔内大出血接受了剖腹手术。给予硫酸镁预防惊厥，给予皮质类固醇（12 mg倍他米松）促进胎儿肺成熟。44例（34.9%）经阴道分娩，82例（65.1%）行剖宫产；另有18例（14.2%）胎儿宫内死产。15例婴儿（11.9%）死亡，26例（20.63%）发生胎盘早剥，14例（11.11%）出现急性肾功能不全，13例（10.31%）术后出现皮下血肿。10例（7.93%）发生孕产妇死亡。
HELLP综合征是一种与孕产妇和围产期并发症高发生率相关的病理情况。HELLP综合征病例的实验室参数在检测围产期结局方面效率不高，但可作为评估孕产妇并发症的风险指标。因此，对于HELLP综合征患者，应采用标准的产前随访方案以获得早期诊断并提高转诊至该领域专业产科科室的速度。
