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

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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