Research Article
BibTex RIS Cite

HELLP sendromunda deksametazon tedavisinin sonuçlar üzerine etkisi

Year 2019, Volume: 52 Issue: 1, 8 - 12, 14.03.2019

Abstract

Amaç: HELLP (Hemolysis, elevated liver enzymes, and low platelets) sendromu
gebeliğin ciddi komplikasyonlarından birisidir. Literatürde HELLP sendromunun
tedavisinde kortikosteroid kullanımı ile ilgili çelişkili bilgiler
bulunmaktadır. Bu çalışmanın amacı deksametazon tedavisinin maternal sonuçlar
üzerindeki etkisinin araştırılmasıdır.



Yöntemler: Çalışmaya HELLP sendromu tanısı ile yoğun bakım ünitesinde izlenen 20
hasta dahil edilmiştir. Hasta yaşı, gestasyonel yaş, Mississipi sınflandırması,
APACHE II skoru, hematolojik ve biyokimyasal ölçümler, mortalite ve yoğun bakım
yatış günü gibi parametreler analiz edilmiştir.



Bulgular: Hastalardan ikisi çoklu organ yetmezliğine bağlı olarak ölmüştür. İki
intrauterine ve bir premature bebek ölümü gerçekleşmiştir. On iki hastaya
deksametazon tedavisi verilmiş (Grup 1), 8 hasta ise kortikosteroid tedavisi
almamıştır. Gruplar arasında yoğun bakım yatış süresi, transfüzyon gereksinimi
ve mortalite açısından anamlı fark saptanmamıştır. Deksametazon tedavisi
verilen grupta trombosit sayılarında artış daha fazla gerçekleşmiştir ancak bu
artış istatistiksel fark yaratacak düzeyde olmamıştır.



Sonuç: HELLP sendromu tedavisinde dekzametazon kullanımı mortalite, yoğun
bakım yatış günü ve trombosit sayılarında anlamlı bir fark yaratmamaktadır.

References

  • 1. Geary M. The HELLP syndrome. Br J ObstetGynaecol 1997, 104:887-91.
  • 2. Sibai BM, Taslimi MM, el-Nazer A, Amon E, Mabie BC, Ryan GM. Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia-eclampsia. Am J Obstet Gynecol. 1986;155:501-9.
  • 3. Sibai BM. The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): much ado about nothing? Am J Obstet Gynecol. 1990;162:311-6.
  • 4. Benedetto C, Marozio L, Tancredi A, Picardo E, Nardolillo P, Tavella AM et al. Biochemistry of HELLP syndrome. Adv Clin Chem. 2011;53:85-104.
  • 5. Abildgaard U, Heimdal K. Pathogenesis of the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP): a review. Eur J Obstet Gynecol Reprod Biol. 2013;166:117-23
  • 6. Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: Clinical issues and management. A Review. BMC Pregnancy and Childbirth 2009, 9:8 doi:10.1186/1471-2393-9-8
  • 7. Hemant K, Chabi S, Frey D. Hellp syndromeJ Obstet Gynecol India Vol. 59, No. 1: January/February 2009 pg 30-40
  • 8. Martin JN Jr, Rose CH, Briery CM. Understanding and managing HELLP syndrome: the integral role of aggressive glucocorticoids for mother and child. Am J Obstet Gynecol. 2006 Oct;195(4):914-34.
  • 9. Martin JN Jr, Thigpen BD, Rose CH, Cushman J, Moore A, Warren al May. Maternal benefit of high-dose intravenous corticosteroid therapy for HELLP syndrome. Am J Obstet Gynecol. 2003;189:830-4.
  • 10. O'Brien JM, Shumate SA, Satchwell SL, Milligan DA, Barton JR. Maternal benefit of corticosteroid therapy in patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome: impact on the rate of regional anesthesia. Am J Obstet Gynecol. 2002;186:475-9.
  • 11. Hemant K, Chabi S, Frey D. Hellp syndromeJ Obstet Gynecol India Vol. 59, No. 1: January/February 2009 pg 30-40
  • 12. Noel ML, Brady CW. Liver disease in pregnancy. World J Gastroenterol 2009 February 28; 15(8): 897-906
  • 13. Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes and low platelet count. Obstet Gynecol 2004;103:981-91.
  • 14. Fonseca JE, Mendez F, Catano C, Arias F: Dexamethasone treatment does not improve the outcome of women with HELLP syndrome: a doubleblind, placebo-controlled, randomized clinical trial. Am J Obstet Gynecol 2005, 193:1591-1598.
  • 15. Thiagarajah S, Bourgeois FJ, Harbert GM Jr, Caudle MR: Thrombocytopenia in preeclampsia: associated abnormalities and management principles. Am J Obstet Gynecol 1984, 150:1-7.
  • 16. van Runnard Heimel PJ, Franx A, Schobben AF, Huisjes AJ, Derks JB, Bruinse HW: Corticosteroids, pregnancy, and HELLP syndrome: a review. Obstet Gynecol Surv 2005, 60:57-70.
  • 17. Magann EF, Bass D, Chauhan SP, Sullivan DL, Martin RW, Martin JN Jr: Antepartum corticosteroids: disease stabilization in patients with the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). Am J Obstet Gynecol 1994, 171:1148-1153.
  • Magann EF, Perry KG Jr, Meydrech EF, Harris RL, Chauhan SP, Martin JN Jr: Postpartum corticosteroids: accelerated recovery from the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). Am J Obstet Gynecol 1994, 171:1154-1158.
  • 19. O'Brien JM, Shumate SA, Satchwell SL, Milligan DA, Barton JR: Maternal benefit of corticosteroid therapy in patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome: impact on the rate of regional anesthesia. Am J Obstet Gynecol 2002, 186:475-479.
  • 20. Rose CH, Thigpen BD, Bofill JA, Cushman J, May WL, Martin JN Jr: Obstetric implications of antepartum corticosteroid therapy for HELLP syndrome. Obstet Gynecol 2004, 104:1011-1014.
  • 21. Vigil-De GP, Garcia-Caceres E: Dexamethasone in the post-partum treatment of HELLP syndrome. Int J Gynaecol Obstet 1997, 59:217-221.
  • 22. Yalcin OT, Sener T, Hassa H, Ozalp S, Okur A: Effects of postpartum corticosteroids in patients with HELLP syndrome. Int J Gynaecol Obstet 1998, 61:141-148. Qureshi NS, Tomlinson AJ: Prenatal corticosteroid therapy for elevated liver enzyme/low platelet count syndrome: a case report. J Reprod Med 2005, 50:64-66.
  • 23. Woudstra DM, Chandra S, Hofmeyr GJ, Dowswell T. Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD008148. doi: 10.1002/14651858.CD008148.pub2.

The Effect of Dexamethasone Treatment on Maternal Outcome in HELLP Syndrome

Year 2019, Volume: 52 Issue: 1, 8 - 12, 14.03.2019

Abstract

Aim: HELLP (Hemolysis, elevated liver enzymes, and low platelets) syndrome
is a serious complication in pregnancy.
There are still
controversies in the literature regarding the role of corticosteroids in the
treatment of HELLP syndrome. The aim of this study is to investigate the effect
of dexamethasone treatment on maternal outcome.

Materials
and methods:
The study included 20 patients who were followed in ICU with the
diagnosis of HELLP syndrome. Data regarding the age, gestational age,
Mississippi class, APACHE II score, hematologic and biochemical measurements,
mortality and length of ICU stay were analyzed retrospectively.

Results: Two patients died due to the multiple organ failure. Two
intrauterine, and one premature mortality occurred. Twelve patient received dexamethasone treatment (Group 1)
and eight patients did not receive steroid treatment (Group 2). There was not
any statistically significant difference in the length of ICU stay, mortality,
and
transfusion requirements between the
groups.

The patients receiving dexamethasone treatment showed an increased improvement
in platelet count; however the difference was not statistically significant.

 









Conclusions:
Dexamethasone treatment did not result in any improvement

in mortality, length of ICU stay, and in the platelet counts in patients with
HELLP syndrome. 

References

  • 1. Geary M. The HELLP syndrome. Br J ObstetGynaecol 1997, 104:887-91.
  • 2. Sibai BM, Taslimi MM, el-Nazer A, Amon E, Mabie BC, Ryan GM. Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia-eclampsia. Am J Obstet Gynecol. 1986;155:501-9.
  • 3. Sibai BM. The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): much ado about nothing? Am J Obstet Gynecol. 1990;162:311-6.
  • 4. Benedetto C, Marozio L, Tancredi A, Picardo E, Nardolillo P, Tavella AM et al. Biochemistry of HELLP syndrome. Adv Clin Chem. 2011;53:85-104.
  • 5. Abildgaard U, Heimdal K. Pathogenesis of the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP): a review. Eur J Obstet Gynecol Reprod Biol. 2013;166:117-23
  • 6. Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: Clinical issues and management. A Review. BMC Pregnancy and Childbirth 2009, 9:8 doi:10.1186/1471-2393-9-8
  • 7. Hemant K, Chabi S, Frey D. Hellp syndromeJ Obstet Gynecol India Vol. 59, No. 1: January/February 2009 pg 30-40
  • 8. Martin JN Jr, Rose CH, Briery CM. Understanding and managing HELLP syndrome: the integral role of aggressive glucocorticoids for mother and child. Am J Obstet Gynecol. 2006 Oct;195(4):914-34.
  • 9. Martin JN Jr, Thigpen BD, Rose CH, Cushman J, Moore A, Warren al May. Maternal benefit of high-dose intravenous corticosteroid therapy for HELLP syndrome. Am J Obstet Gynecol. 2003;189:830-4.
  • 10. O'Brien JM, Shumate SA, Satchwell SL, Milligan DA, Barton JR. Maternal benefit of corticosteroid therapy in patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome: impact on the rate of regional anesthesia. Am J Obstet Gynecol. 2002;186:475-9.
  • 11. Hemant K, Chabi S, Frey D. Hellp syndromeJ Obstet Gynecol India Vol. 59, No. 1: January/February 2009 pg 30-40
  • 12. Noel ML, Brady CW. Liver disease in pregnancy. World J Gastroenterol 2009 February 28; 15(8): 897-906
  • 13. Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes and low platelet count. Obstet Gynecol 2004;103:981-91.
  • 14. Fonseca JE, Mendez F, Catano C, Arias F: Dexamethasone treatment does not improve the outcome of women with HELLP syndrome: a doubleblind, placebo-controlled, randomized clinical trial. Am J Obstet Gynecol 2005, 193:1591-1598.
  • 15. Thiagarajah S, Bourgeois FJ, Harbert GM Jr, Caudle MR: Thrombocytopenia in preeclampsia: associated abnormalities and management principles. Am J Obstet Gynecol 1984, 150:1-7.
  • 16. van Runnard Heimel PJ, Franx A, Schobben AF, Huisjes AJ, Derks JB, Bruinse HW: Corticosteroids, pregnancy, and HELLP syndrome: a review. Obstet Gynecol Surv 2005, 60:57-70.
  • 17. Magann EF, Bass D, Chauhan SP, Sullivan DL, Martin RW, Martin JN Jr: Antepartum corticosteroids: disease stabilization in patients with the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). Am J Obstet Gynecol 1994, 171:1148-1153.
  • Magann EF, Perry KG Jr, Meydrech EF, Harris RL, Chauhan SP, Martin JN Jr: Postpartum corticosteroids: accelerated recovery from the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). Am J Obstet Gynecol 1994, 171:1154-1158.
  • 19. O'Brien JM, Shumate SA, Satchwell SL, Milligan DA, Barton JR: Maternal benefit of corticosteroid therapy in patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome: impact on the rate of regional anesthesia. Am J Obstet Gynecol 2002, 186:475-479.
  • 20. Rose CH, Thigpen BD, Bofill JA, Cushman J, May WL, Martin JN Jr: Obstetric implications of antepartum corticosteroid therapy for HELLP syndrome. Obstet Gynecol 2004, 104:1011-1014.
  • 21. Vigil-De GP, Garcia-Caceres E: Dexamethasone in the post-partum treatment of HELLP syndrome. Int J Gynaecol Obstet 1997, 59:217-221.
  • 22. Yalcin OT, Sener T, Hassa H, Ozalp S, Okur A: Effects of postpartum corticosteroids in patients with HELLP syndrome. Int J Gynaecol Obstet 1998, 61:141-148. Qureshi NS, Tomlinson AJ: Prenatal corticosteroid therapy for elevated liver enzyme/low platelet count syndrome: a case report. J Reprod Med 2005, 50:64-66.
  • 23. Woudstra DM, Chandra S, Hofmeyr GJ, Dowswell T. Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD008148. doi: 10.1002/14651858.CD008148.pub2.
There are 23 citations in total.

Details

Primary Language English
Journal Section Original research article
Authors

Hatice Kaya Özdoğan

Sevtap Seyfettinoğlu This is me

Sibel Çetinalp This is me

Faruk Karateke This is me

Sibel Tetiker This is me

Raziye Narin This is me

Publication Date March 14, 2019
Submission Date January 1, 2019
Published in Issue Year 2019 Volume: 52 Issue: 1

Cite

AMA Kaya Özdoğan H, Seyfettinoğlu S, Çetinalp S, Karateke F, Tetiker S, Narin R. The Effect of Dexamethasone Treatment on Maternal Outcome in HELLP Syndrome. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. March 2019;52(1):8-12.