#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

A delay in the HELLP syndrome diagnosis


Authors: J. Záhumenský 1;  E. Menzlová 1;  H. Hermann 2;  B. Zmrhalová 1;  O. Šottner 1;  I. Vašíčka 1;  M. Halaška 1
Authors‘ workplace: Gynekologicko‑porodnická klinika 1. lékařské fakulty UK a FN Na Bulovce Praha, přednosta prof. MU Dr. Michael Halaška, DrSc. 2 Ústav pro péči o matku a dítě Praha 4, ředitel doc. MU Dr. Jaroslav Feyereisl, CSc. 1
Published in: Vnitř Lék 2011; 57(1): 113-116
Category: Case Reports

Overview

HELLP syndrome is a serious obstetrical complication that tends to occur in the second half of pregnancy that complicates six promiles of pregnancies. The term HELLP syndrome is derived from the beginning letters of the English words indicating laboratory changes, which is occurs as a specific illness in pregnancy. There is hemolysis, elevated liver enzymes and a decreased platelet count. It can present itself with preeclampsia or without it. The most serious complications are disseminated intravascular coagulation, liver rupture or various organ failures. The pathogenesis at the moment is not completely known. The basic approach to care is delivery at the earliest possible term. HELLP syndrome generally arises in the second or third trimester of pregnancy, but can also occur after delivery. It has typical signs, which can also arise due to other liver diseases, but more frequently in diseases of the gall bladder, which in pregnancy given the physiological changes in the body of the pregnant women is also predisposed. In this context, woman with this problem can seek out other physicians than obstetricians. In our case, we wanted to refer to the needs of early diagnosis of this frequently diagnosed illness, since in the case of late diagnosis and a woman not sent to the obstetrical department can lead to a serious life threatening state for the mother and child.

Key words:
HELLP syndrom –  pregnancy –  preeclampsia –  hepatopathie


Sources

1. Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy Am J Obstet Gynecol 2005; 193: 859.

2. Egerman RS, Sibai BM. HELLP syndrome. Clin Obstet Gynecol 1999; 42: 381– 389.

3. Mihu D, Costin N, Mihu CM et al. HELLP syndrome –  a multisystemic disorder. J Gastrointestin Liver Dis 2007; 16: 419– 424.

4. Lee NM, Brady CW. Liver disease in pregnancy. World J Gastroenterol 2009; 15: 897– 906.

5. Illsinger S, Janzen N, Sander S et al. Preeclampsia and HELLP syndrome: impaired mitochondrial function in umbilical endothelial cells. Reprod Sci 2010; 17: 219– 226.

6. Muetze S, Leeners B, Ortlepp JR et al. Maternal factor V Leiden mutation is associated with HELLP syndrome in Caucasian women. Acta Obstet Gynecol Scand 2008; 87: 635– 642.

7. Prochazka M, Happach C, Marsal K et al. Factor V Leiden in pregnancies complicated by placental abruption. BJOG 2003; 110: 462– 466.

8. Prochazka M, Lubusky M, Slavik L et al. Frequency of selected thrombophilias in women with placental abruption. Aust N Z J Obstet Gynaecol 2007; 47: 297– 301.

9. Beucher G, Simonet T, Dreyfus M. Management of the HELLP syndrome. Gynecol Obstet Fertil 2008; 36: 1175– 1190.

10. Glantz A, Marschall HU, Lammert F et al. Intrahepatic cholestasis of pregnancy: a randomized controlled trial comparing dexamethasone and ursodeoxycholic acid. Hepatology 2005; 42: 1399– 1405.

11. Sibai BM, Ramadan MK, Usta I et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol 1993; 169: 1000– 1006.

12. Sibai BM, Caritis S, Hauth J. What we have learned about preeclampsia. Semin Perinatol 2003; 27: 239– 246.

13. Fonseca JE, Mendez F, Catano C et al. Dexamethasone treatment does not improve the outcome of women with HELLP syndrome: a double-blind, placebo- controlled, randomized clinical trial. Am J Obstet Gynecol 2005; 193: 1591– 1598.

14. Hupuczi P, Nagy B, Sziller I et al. Characteristic laboratory changes in pregnancies complicated by HELLP syndrome. Hypertens Pregnancy 2007; 26: 389– 401.

15. Shames BD, Fernandez LA, Sollinger HW et al. Liver transplantation for HELLP syndrome. Liver Transpl 2005; 11: 224– 228.

16. Zarrinpar A, Farmer DG, Ghobrial RM et al. Liver transplantation for HELLP syndrome. Am Surg 2007; 73: 1013– 1016.

17. Sibai BM, Ramadan MK, Chari RS et al. Pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): subsequent pregnancy outcome and long-term prognosis. Am J Obstet Gynecol 1995; 172: 125– 129.

18. Sullivan CA, Magann EF, Perry jr. KG et al. The recurrence risk of the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP) in subsequent gestations. Am J Obstet Gynecol 1994; 171: 940– 943.

19. Ch‘ng CL, Morgan M, Hainsworth I et al. Prospective study of liver dysfunction in pregnancy in Southwest Wales. Gut 2002; 51: 876– 880.

20. Ko CW, Beresford SA, Schulte SJ et al. Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy. Hepatology 2005; 41: 359– 365.

21. Ko CW, Beresford SA, Schulte SJ et al. Insulin resistance and incident gallbladder disease in pregnancy. Clin Gastroenterol Hepatol 2008; 6: 76– 81.

22. Gilat T, Konikoff F Pregnancy and the biliary tract. Can J Gastroenterol 2000; 14 (Suppl D): 55D– 59D.

23. Graham G, Baxi L, Tharakan T. Laparoscopic cholecystectomy during pregnancy: a case series and review of the literature. Obstet Gynecol Surv 1998; 53: 566– 574.

24. Tham TC, Vandervoort J, Wong RC et al. Safety of ERCP during pregnancy. Am J Gastroenterol 2003; 98: 308– 311.

25. Simetka O, Michalec I, Zewdiova H et al. Course and delivery outcomes of 34 pregnancies complicated by HELLP syndrom. Česká Gynekol 2010; 75: 242– 247.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 1

2011 Issue 1

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#