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

Year 2019, , 48 - 54, 25.03.2019

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

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

Abstract

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.

Keywords

Şiddetli preeklampsi, HELLP sendromu, Maternal sonuçlar, Perinatal sonuçlar

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

Abstract

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.

Keywords

severe preeclampsia, HELLP syndrome, maternal outcome, perinatal outcome

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