KLİNİĞİMİZDE HELLP SENDROMU TANISI ALAN OLGULARIN RETROSPEKTİF OLARAK DEĞERLENDİRİLMESİ Retrospective Evaluation of Patients With Hellp Syndrome In Our Clinic

Yıl 2019, Cilt: 9 Sayı: 4, 78 - 82, 27.12.2019

Demet Aydoğan Kırmızı Emre Başer Taylan Onat Melike Demir Çaltekin Mustafa Kara Ethem Serdar Yalvaç

Öz

ÖZET

Amaç: Bu çalışmanın amacı kliniğimize başvuran pre-eklampsi vakalarından HELLP sendromu gelişen olguların
klinik, biyokimyasal değişikliklerinin, maternal ve fetal komplikasyonlarının incelenmesidir.
Gereç ve Yöntemler: Ocak 2017-Mart 2019 tarihleri arasında Bozok Üniversitesi Tıp Fakültesi Kadın Hastalıkları
ve Doğum kliniğinde yatırılan 56 pre-eklamptik hastadan HELLP sendromu gelişen olgular retrospektif olarak
incelendi. Tüm olguların klinik, laboratuvar parametreleri, fetal ve maternal komplikasyonları değerlendirildi.
Bulgular: Kliniğimizde yatırılan 56 pre-eklamptik gebenin 22 ‘si ağır (% 39,2) , 34’ü (% 60,8) hafif pre-eklampsi
idi. Şiddetli pre-eklampsi vakalarından 3 tanesinde HELLP sendromu geliştiği saptandı. HELLP Sendromu
gelişen 3 vakamızın yaşları 33,31 ve 26 idi. Hastalardan ikisi multipardı. Primigravid olan hastamız 20.gebelik
haftasında bulunmaktaydı. Diğerleri 38 ve 36. gestasyonel haftalarda idi. Ortalama vücut kitle indeksi değerleri
28.1 idi. Trombosit sayısı tüm hastalarda <100.000 mm3 idi. Ortalama AST , ALT ve LDH değerleri sırasıyla
266.66 IU/L, 432 IU/L, 1006.66 IU/L idi. Çalışma dönemimizdeki pre-eklampsi insidansı % 5.6, HELLP insidansı
% 0.3 olarak saptandı. Maternal ve fetal mortalite gözlenmedi.
Sonuç: Gebeliğin hipertansif hastalıkları maternal ve fetal komplikasyonlar gelişmesine neden olabilir. HELLP
sendromu tüm obstetrisyenlerin erken tanı koyması gereken ve hızlı tedavi gerektiren önemli bir obstetrik
komplikasyondur.
Anahtar Kelimeler: HELLP sendromu; Pre-eklampsi; Gebelik.
ABSTRACT
Aim: The aim of this study was to investigate the clinical, biochemical, and maternal and fetal complications
of HELLP syndrome in pre-eclampsia cases.
Material and Methods: HELLP syndrome cases were evaluated retrospectively in 56 pre-eclamptic patients
admitted to our clinic (Bozok University Faculty of Medicine, Department of Gynecology and Obstetrics)
between January 2017 and March 2019. Clinical and laboratory parameters, fetal and maternal complications
were evaluated.
Results: Of the 56 preeclamptic women hospitalized in our clinic, 22 were severe (39.2%) and 34 (60.8%) were
mild pre-eclampsia. Three cases of severe pre-eclampsia developed HELLP syndrome. The age of the cases
with HELLP syndrome was 33, 31 and 26 years, respectively. Two of the patients were multiparous. Our patient
who was primigravid was in the 20th week of pregnancy. The others were at 38 and 36 gestational weeks. The
mean BMI values were 28.1. The platelet count was <100 .000 / mm3 in all patients. Mean AST, ALT and LDH
values were 266.66 IU / L, 432 IU / L, 1006.66 IU / L, respectively. Pre-eclampsia incidence was 5.6% and HELLP
incidence was 0.3%. No maternal and fetal mortality was observed.
Conclusion: Hypertensive diseases of pregnancy may cause maternal and fetal complications. HELLP syndrome
is an important obstetric complication that requires early diagnosis of all obstetricians and requires rapid
treatment.
Keywords: HELLP syndrome, preeclampsia, pregnancy.

Anahtar Kelimeler

KLİNİĞİMİZDE HELLP SENDROMU TANISI ALAN OLGULARIN RETROSPEKTİF OLARAK DEĞERLENDİRİLMESİ Retrospective Evaluation of Patients With Hellp Syndrome In Our Clinic

Kaynakça

• 1. Pritchard J, Weisman Jr R, Ratnoff O, Vosburgh G. Intravascular hemolysis, thrombocytopenia and other hematologic abnormalities associated with severe toxemia of pregnancy. New England Journal of Medicine. 1954;250(3):89-98. 2. Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. American journal of obstetrics and gynecology. 1982;142(2):159-67. 3. Saphier CJ, Repke JT, editors. Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome: a review of diagnosis and management. Seminars in perinatology; 1998: Elsevier. 4. 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. American journal of obstetrics and gynecology. 1996;175(2):460-4. 5. Magann EF, Perry Jr KG, Meydrech EF, Harris RL, Chauhan SP, Martin Jr JN. Postpartum corticosteroids: accelerated recovery from the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). American journal of obstetrics and gynecology. 1994;171(4):1154-8. 6. Onrust S, Santema JG, Aarnoudse JG. Pre-eclampsia and the HELLP syndrome still cause maternal mortality in the Netherlands and other developed countries; can we reduce it? European Journal of Obstetrics & Gynecology and Reproductive Biology. 1999;82(1):41-6. 7. Sibai BM, Barton JR. Expectant management of severe preeclampsia remote from term: patient selection, treatment, and delivery indications. American journal of obstetrics and gynecology. 2007;196(6):514. e1-. e9. 8. Gracia VD, Rojas‐Suarez J, Ramos E, Reyes O, Collantes J, Quintero A, et al. Incidence of eclampsia with HELLP syndrome and associated mortality in Latin America. International Journal of Gynecology & Obstetrics. 2015;129(3):219-22. 9. Kumru S, Simsek M, Gurates B, Sapmaz E, Ozcan Z, Nalbant M. Comparison of maternal and perinatal outcomes of HELLP syndrome and severe preeclampsia cases. Perinatal Journal. 2005;13(1):9-14. 10. Martin Jr JN, 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. American journal of obstetrics and gynecology. 1999;180(6):1373-84. 11. Abramovici D, Friedman SA, Mercer BM, Audibert F, Kao L, Sibai BM. Neonatal outcome in severe preeclampsia at 24 to 36 weeks' gestation: does the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome matter? American journal of obstetrics and gynecology. 1999;180(1):221-5. 12. TANER CE, ERDEN AC, KOCABAĞLI C, DEMİROĞLU S, Kadın OBÜTF, AD H. HELLP Sendromu 12 Olgu ve Tedavide Yaklaşımlar.Turkiye Klinikleri Journal of Gynecology and Obstetrics. 1993;3(2):129-33. 13. M.Sibai. B. Gabbe SG , Nibley JR, Simpson JL,eds. Obstetrics Normal and problem pregnancies 4 th ed ed: Churchill Livingstone; 2002. 14. Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstetrics & Gynecology. 2004;103(5):981-91. 15. Norwitz ER, Hsu C-D, Repke JT. Acute complications of preeclampsia. Clinical obstetrics and gynecology. 2002;45(2):308-29. 16. Magann EF, Bass D, Chauhan SP, Sullivan DL, Martin RW, Martin Jr JN. Antepartum corticosteroids: disease stabilization in patients with the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). American journal of obstetrics and gynecology. 1994;171(4):1148-53. 17. Segal S, Shenhav S, Gemer O. Thrombocytopenia with the HELLP syndrome. Report of two cases with reversal in normotensive and nonproteinuric gravidas. The Journal of reproductive medicine. 1998;43(3):227-9. 18. Esan K, Moneim T, Page I. Postpartum HELLP syndrome after a normotensive pregnancy. Br J Gen Pract. 1997;47(420):441-2. 19. Laughon SK, Zhang J, Troendle J, Sun L, Reddy UM. Using a simplified Bishop score to predict vaginal delivery. Obstetrics and gynecology. 2011;117(4):805-11. 20. Ruff RL, Dougherty JH, Jr. Complications of lumbar puncture followed by anticoagulation. Stroke. 1981;12(6):879-81.