Magnin G, Pourrat O, Magnin P
Clinique Gynécologique et Obstétricale, Hôpital Jean Bernard, Poitiers.
Bull Acad Natl Med. 1993 Feb;177(2):247-59; discussion 259-61.
Preeclampsia is a multisystem disorder of pregnancy whose clinical presentation is related to the importance and the extent of maternal microvasculature damage. 16 patients with preeclampsia, thrombocytopenia (< 100,000/mm3), elevated liver enzymes and hemolysis are described. Weinstein in 1982 assigned the acronym of Hellp syndrome for this clinical presentation of preeclampsia. This syndrome was seldom recognized during the first years of the study but was diagnosed later on, in 1 pregnancy out of 600 parturitions and in 5% of preeclampsia in 1991. Two out of the patients developed eclamptic seizures. The mode of delivery was as follows: 9 out of 16 had an emergency Caesarean section; the 7 other patients had vaginal delivery after induction of labor. Delivery occurred before 32 weeks of gestation for 6 out of 17 newborns. Outcome was good for 14 of the 17 newborns (one twin pregnancy). Two fetuses died: one in utero and one during interruption of the pregnancy at 24 weeks of gestation. A small for gestational age preterm of 32 weeks died on his second day of life. Early diagnosis of Hellp Syndrome, especially when abdominal pains are present, allows a prompt management of these patients, including delivery, which appeared in our experience, the only way to avoid fetomaternal complications. The thrombotic microangiopathics and acute fatty liver of pregnancy are potential imitations of Hellp syndrome and they must be considered for differential diagnosis. The frequency of Hellp Syndrome varies from one study to another. It can be increased up to 6 fold if referred to the number of pregnancies and up to 3 fold if referred to the number of preeclampsias. These differences can be real but may be due to bias related to differences in practice between centers and also differences in definitions of Hellp Syndrome and preeclampsia.
子痫前期是一种妊娠多系统疾病，其临床表现与母体微血管损伤的严重程度和范围相关。本文描述了16例患有子痫前期、血小板减少（<100,000/mm³）、肝酶升高和溶血的患者。1982年，温斯坦将这种子痫前期的临床表现首字母缩写为Hellp综合征。在研究的最初几年，这种综合征很少被认识到，但后来在1991年，每600例分娩中有1例被诊断出，在子痫前期患者中占5%。其中2例患者发生了子痫抽搐。分娩方式如下：16例中有9例行急诊剖宫产；其他7例患者在引产后宫口分娩。17例新生儿中有6例在妊娠32周前分娩。17例新生儿中有14例（1例双胎妊娠）结局良好。2例胎儿死亡：1例宫内死亡，1例在妊娠24周时引产过程中死亡。1例32周的小于胎龄早产儿在出生第二天死亡。Hellp综合征的早期诊断，尤其是在出现腹痛时，有助于对这些患者进行及时处理，包括分娩，根据我们的经验，这是避免母婴并发症的唯一方法。血栓性微血管病和妊娠急性脂肪肝是Hellp综合征的潜在模仿疾病，在鉴别诊断时必须予以考虑。Hellp综合征的发生率因研究而异。如果参照妊娠次数，其发生率可增加至6倍；如果参照子痫前期患者数量，可增加至3倍。这些差异可能是真实存在的，但也可能是由于不同中心之间实践差异以及Hellp综合征和子痫前期定义差异导致的偏差。
