Şiddetli Preeklampsiye Eşlik Eden HELLP Sendromu Olgularında Maternal ve Perinatal Sonuçların Değerlendirilmesi

Yıl 2019, Cilt: 11 Sayı: 1, 48 - 54, 25.03.2019

Taner Günay Abdulkadir Turgut Oğuz Devrim Yardımcı Ergül Demirçivi Bör Gökhan Göynümer

https://doi.org/10.18521/ktd.451746

Öz

Amaç: Şiddetli preeklamsiye eşlik
eden HELLP (hemoliz,yükselmiş karaciğer enzimleri,düşük trombosit sayısı)
sendromu olguları ile HELLP sendromu olmaksızın sadece şiddetli preeklamsi
olgularında maternal ve perinatal sonuçların karşılaştırılmasıdır.

Gereç ve Yöntemler: Hastanemizde 2015 Ocak ile
2018 Temmuz tarihleri arasında takip edilerek doğumu gerçekleşen şiddetli
preeklampsi tanısı alan gebeler (Grup 1) ile şiddetli preeklampsiye eşlik eden
HELLP sendromu tanısı alan gebeler (Grup 2) retrospektif olarak
değerlendirildi. Her iki gruptaki gebelerde intruterin gelişme geriliği,
preterm doğum, dekolman plasenta ve fetal ölüm gibi komplikasyonların yanında maternal
morbidite ve mortalite artışına sebep olabilen durumlar ile hematolojik ve
biyokimyasal parametreler açısından karşılaştırıldı.

Bulgular: 2015
Ocak ile 2018 Temmuz arasında hastanemizde toplam 8730 doğum gerçekleşti ve 154
(%1.7) gebeye şiddetli preeklampsi (Grup 1), 38 (%0.4) gebeye ise şiddetli
preeklampsi+HELLP (Grup 2) sendromu tanısı konuldu. Grup 1’de intrauterin
gelişme geriliği 22 (%14.2), dekolman plasenta 8 (%5.2), preterm doğum %32.4
oranında görülürken, Grup 2’de ise bu oranlar sırasıyla 7 (%18.4), 3 (%7.8) ve
% 26.3 olarak bulundu ve gruplar arasında anlamlı fark bulunmadı. Fetal ölüm
oranları (%1.2’ye %5.2) ve sezaryen doğum oranları (%77.2’ye %86.8) açısından
da gruplar açısından anlamlı fark bulunmamasına rağmen oranlar Grup 2’de daha
yüksekti. Akut böbrek yetmezliği, dissemine intravasküler koagülasyon, yoğun
bakım ihtiyacı ile kan ve kan ürünü transfüzyonu ihtiyacı da Grup 2’de daha
fazla bulundu ve gruplar arasında istatistiksel anlamlı fark tespit edildi.

Sonuç: Şiddetli
preeklampsi ve özellikle şiddetli preeklampsiye eşlik eden HELLP sendromu
varlığı perinatal komplikasyonların yanında ciddi maternal morbidite ve
mortalite artışı ile birliktelik göstermekte olup mümkün olan en kısa zamanda
gebeliğin sonlandırılması ve uygun destek tedavisinin verilmesi gerekmektedir.

Anahtar Kelimeler

Şiddetli preeklampsi, HELLP sendromu, Maternal sonuçlar, Perinatal sonuçlar

Evaluation of maternal and perinatal outcomes in severe preeclampsia with and without HELLP syndrome

Öz

Objective:
Our objective in current study was to compare the
severe preeclampsia with HELLP syndrome coexisting with preeclampsia in terms
of maternal and perinatal outcomes.

Methods:
We retrospectively picked the pregnancies with
severe preeclampsia (Group 1) and severe preeclampsia with HELLP syndrome
(Group 2) who were diagosed and treated between January 2015 and July 2015 in
our hospital. In addition to maternal mortality and morbidity rates,
complications such as intrauterine growth retardation, preterm delivery,
placental ablation and fetal death rates were compared with hematologic and
biochemical parameters in both groups.

Results:
Between January 2015 and July 2018, a total of 8730
deliveries were made in our hospital. 154 (1.7%) pregnant women had got a
diagnosis of severe preeclampsia without HELLP syndrome parameters (Group 1).
38 (0.4%) had got a diagnosis of severe preeclampsia with HELLP syndrome (Group
2). In Group 1, 22 cases had intrauterine growth restriction (14.2%). 8 cases
had placental ablation (5.2%), 50 cases had preterm delivery (32.4%). In Group
2, 7 cases had intrauterine growth restriction (18.4%), 3 cases had placental
ablation (7.8%) and 10 cases had preterm delivery (26.3%). There was no
statistically significant difference between two groups in terms of all these
three parameters. Although there were no significant differences, fetal
mortality rates (1.2% vs 5.2%) and cesarean delivery rates (77.2% vs 86.8%)
were higher in Group 2. We detected significant differences in terms of acute
renal failure and disseminated intravascular coagulopathy rates, need for
invasive care and need for blood product transfusion between groups. All were
higher in Group 2.

Conclusion: Severe preeclampsia, particularly ones together with HELLP
syndrome, are related to high perinatal complications and increased maternal
mortality and morbidity, It is necessary to terminate such pregnancies and to
provide appropriate supportive therapy in time.

Anahtar Kelimeler

severe preeclampsia, HELLP syndrome, maternal outcome, perinatal outcome

Kaynakça

• Saftlas AF, Olson DR, Franks AL, et al. Epidemiology of preeclampsia and eclampsia in the United States, 1979-1986. Am J Obstet Gynecol. 1990;163(2):460-5.
• Bulletins--Obstetrics ACoP. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Obstet Gynecol. 2002;99(1):15967.
• Hauth JC, Ewell MG, Levine RJ, Esterlitz JR, Sibai B, Curet LB, Catalano PM, Morris CD: Pregnancy outcomes in healthy nulliparas who developed hypertension. Obstet Gynecol 2000 95:24.
• Weinstein L.Syndrome of hemolysis,elevated liver enzymes,and low platelet count:a severe consequence of hypertension in pregnancy. Am.J.Obstet.Gynecol. 1982;142:159-167.
• Excellence HlfHaC, Hypertension in Pregnancy: The management of Hypertensive disorders during pregnancy, NICE clinical guideline, 2010, vol.107, pp 1-53.
• Sibai BM. The HELLP syndrome (hemolysis, elevated liver enzyme levels, and low platelets): much ado about nothing? Am J Obstet Gynecol 1990;162:311-6.
• David K,James S,Philip J.Steer,Carl P.Weiner,Bernard Ganik High Risk Pregnancy:managment options 2008 bölüm 50 Renal Bozukluklar s. 1104-5
• Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 2004;103(5 Pt 1):981-91.
• Uzan J CM, Piconne O, Asmar R, Ayoubi JM. Pre-eclampsia: pathophysiology, diagnosis, and management. Vasc Health Risk Manag. 2011;7:467-74.
• Chesley LC:Hypertensive disorders in pregnancy.New York,AppletonCentury-Crofts,1978
• Caritis S,Sibai B,Hauth J,et al:Low-dose aspirin to prevent preeclampsia in women at high risk.National Instutute of Child Health and Human Development Network of Maternal-Fetal Units(see comments).N Engl J Med 338:701,1998.
• Chesley LC:Hypertension in pregnancy:Definitions,familial factor,and remote prognosis. Kidney Intl 18:234,1980.
• Sibai BM,El-Nazer A,Gonzales-RuizA:Severe preeclampsia-eclampsia in young primigravid women:Subsequent pregnancy outcome and remote prognosis.Am J Obstet Gynecol 155:1011,1986.
• Selahattin Kumru, Mehmet Şimşek, Bilgin Güratefl, Ekrem Sapmaz, Zeynep Özcan,Mehmet Nalbant, Denizmen Aygün: Comparison of Maternal and Perinatal Outcomes of HELLP Syndrome and Severe Preeclampsia Cases. Perinatal Journal • Vol: 13, Issue: 1/March 2005).
• Abramovici D, Friedman SA, Mercer BM, Audibert F, Kao L, Sibai BM. Am J Neonatal outcome in severe preeclampsia at 24 to 36 weeks' gestation: does the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome matter? Obstet Gynecol. 1999 Jan;180(1 Pt 1):221-5.
• Chesley LC, Cooper DW: Genetics of hypertension in pregnancy: Possible single gene control of preeclampsia and eclampsia in the descendants of eclamptic women. Br J Obstet Gynecol 1986, 93:898-908
• Harms K, Rath W, Herting E, Kuhn W. Maternal hemolysis, elevated liver enzymes, low platelet count and neonatal outcome.Am J Perinatol 1995;1(12):1-6.
• Ching-Ming Liu, Shuenn-Dyh Chang, Po-Jen Cheng and An-Shine Chao:Comparisons of maternal and perinatal outcomes in Taiwanese women with complete and partial HELLP syndrome and women with severe preeclampsia without HELLP. J. Obstet. Gynaecol. Res. Vol. 32, No. 6: 550–558, December 2006.
• Martin JN, Blake PG, Lowry SL, Perry KG, Files JC, Morrison JC.Pregnancy complicated by preeclampsia-eclampsia with the HELLP syndrome: how rapid is post partum recovery? Obstet Gynecol 1990;76:737-41.
• Sibai BM, Taslimi MM, El-Nazer A, Amon E, Mabie CB, Ryan GM. Maternalperinatal 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.
• Audibert F, Friedman SA, Frangieh AY, Sibai BM. Clinical utility of strict diagnostic criteria for the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Am J Obstet Gynecol 1996;175:460-4.
• Martin JN Jr, Rinehart BK, May WL, Magann EF, Terrone DA, Blake PG:The spectrum of severe preeclampsia: comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification.Am J Obstet Gynecol. 1999 Jun;180(6 Pt 1):1373-84.
• Reubinoff BE, Schenker JG. HELLP syndrome—a syndrome of hemolysis, elevated liver enzymes and low platelet count—complicating preeclampsiaeclampsia. Int J Gynecol Obstet 1991;36:95-102.
• Geary M. The HELLP syndrome. Br J Obstet Gynaecol 1997;104:887-91.
• Haddad B, Barton JR, Livingston JC, Chahine R, Sibai BM.HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome versus severe preeclampsia: onset at < or=28.0 weeks' gestation. Am J Obstet Gynecol 2000(a); 183:1475-9.
• Raval DS, Co S, Reid MA, Pildes R. Maternal and neonatal outcome of pregnancies complicated with maternal HELLP syndrome. J Perinatol 1997; 17: 266-9.
• van Pampus MG, Wolf H, Ilsen A, Treffers PE. Maternal outcome following temporizing management of the (H)ELLP syndrome. Hypertens Pregnancy 2000; 19: 211-20.
• Pritchard JA, Mac Donald PC, Gant NF: Williams Obstetrics (17th ed).Appleton Century-Crofts, Norwalk 1985.
• Plouin PF,Chatellier G,Breart G, et al:Frequency and perinatal consequences of hypertensive disease of pregnancy.Adv Nephrol 57:69,1986.
• Anumba DO, Robson SC. Management of pre-eclampsia and haemolysis, elevated liver enzymes, and low platelets syndrome. Curr Opin Obstet Gynecol 1999;11:149–56.
• Sibai BM, Taslimi M, Abdella TN, Brooks TF, Spinnato JA, Anderson GD. Maternal and perinatal outcome of conservative management of severe preeclampsia in midtrimester. Am J Obstet Gynecol 1985;152:32–7.
• Eeltink CM, van Lingen RA, Aarnoudse JG, Derks JB, Okken A.Maternal haemolysis, elevated liver enzymes and low platelets syndrome: specific problems in the newborn. Eur J Pediatr 1993;152:160-3.
• van Dam PA, Renier M, Baekelandt M, Buytaert P, Byttenbroeck F. Disseminated intravascular coagulation and the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia. Obstet Gynecol 1989;73:970-102.
• Magann EF, Perry KG, Chauhan SP, Graves GR, Blake PG, Martin JN Jr. Neonatal salvage by weeks’ gestation in pregnancies complicated by HELLP syndrome. J Soc Gynecol Invest 1994;1:206-9.