Audibert F, Coffineau A, Edouard D, Brivet F, Ville Y, Frydman R, Fernandez H
Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Clamart.
Presse Med. 1996 Feb 17;25(6):235-9.
Assess expression and management of HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) occurring before 32 weeks gestation.
Among 50 patients presenting HELLP syndrome from 1990 to 1994, 22 (44%) who developed the syndrome before 32 weeks gestation were evaluated retrospectively.
Most of the patients were primiparous and HELLP syndrome recurred in 2 during a second gestation before 32 weeks gestation. Only three cases began during the post partum period. All patients had severe pre-eclampsia before discovery of the HELLP syndrome. Episodes of eclampsia also occurred in 6. The most frequent clinical manifestation was epigastric pain. Ten patients had acute severe renal failure. The 3 post partum patients had severe complications (eclampsia, renal failure, subcapsular hepatic hematoma). Obstetrical intervention was required in all cases. Cesarean section was performed within 48 hours of diagnosis. Pregnancy had to be terminated in 3 cases between 24 and 29 weeks gestation. There was one fetal death in utero and one during the neonatal period. Seventeen live infants were delivered. In the group of 11 infants born after 30 weeks gestation, only 1 had hyalin membrane disease which developed in all those born before 30 weeks, including 2 with broncho-pulmonary dysplasia.
Based on the physiological mechanisms involved in HELLP syndrome, criteria for obstetrical extraction and the possibilities for conservative management in very premature pregnancies, we propose a management protocol for HELLP syndrome developing before 32 weeks gestation. Corticosteroid therapy may be given for 48 hours in cases without maternal or fetal complications in order to accelerate fetal maturation before extraction.
评估妊娠32周前发生的HELLP综合征（溶血、肝酶升高、血小板计数降低）的表现及处理。
回顾性评估1990年至1994年间出现HELLP综合征的50例患者，其中22例（44%）在妊娠32周前发生该综合征。
大多数患者为初产妇，2例在妊娠32周前的第二次妊娠中复发HELLP综合征。仅3例在产后发病。所有患者在发现HELLP综合征之前均有重度子痫前期。6例发生子痫发作。最常见的临床表现是上腹部疼痛。10例患者发生急性严重肾衰竭。3例产后患者出现严重并发症（子痫、肾衰竭、肝包膜下血肿）。所有病例均需产科干预。诊断后48小时内进行剖宫产。3例在妊娠24至29周之间终止妊娠。1例胎儿宫内死亡，1例新生儿期死亡。分娩出17例活婴。在妊娠30周后出生的11例婴儿中，仅1例发生透明膜病，而在妊娠30周前出生的所有婴儿均发生该病，其中2例合并支气管肺发育不良。
基于HELLP综合征涉及的生理机制、产科分娩标准以及极早产保守治疗的可能性，我们提出了妊娠32周前发生的HELLP综合征的处理方案。对于无母婴并发症的病例，可给予48小时的皮质类固醇治疗，以便在分娩前加速胎儿成熟。
