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. 2006 Mar 2;124(2):85-9.
doi: 10.1590/s1516-31802006000200007.

Maternal outcome in HELLP syndrome requiring intensive care management in a Turkish hospital

Mehmet Armagan Osmanagaoglu  1 , Selen Osmanagaoglu, Hülya Ulusoy, Hasan Bozkaya
Affiliations

Maternal outcome in HELLP syndrome requiring intensive care management in a Turkish hospital

Mehmet Armagan Osmanagaoglu et al. Sao Paulo Med J. .

Abstract
in English, Portuguese

Context and objective: Despite the development of tertiary care facilities, intensive care and advanced blood banking techniques, pregnancy-related hypertensive disorders are the main cause of maternal mortality in most countries. Our purpose was to determine maternal outcome in pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count) that required intensive care management.

Design and setting: Retrospective study at Department of Obstetrics and Gynecology, and Department of Anesthesiology and Reanimation, Karadeniz Technical University, Trabzon, Turkey.

Methods: 37 patients with HELLP syndrome admitted to the obstetric intensive care unit were analyzed retrospectively from 1992 to 2004.

Results: All patients were hypertensive, with mean Glasgow coma score (GCS) of 11 +/- 3.96. Mean gestational age at delivery was 32 +/- 4.09 weeks. Delivery was vaginally in nine and by cesarean section in 27 patients. General anesthesia was used in 12 and spinal anesthesia in 25 patients. Maternal morbidity included acute renal failure (11%), disseminated intravascular coagulation (5%), acute lung edema (3%), severe ascites (11%), pleural effusion (3%), adult respiratory distress syndrome (11%), abruptio placenta (11%), cerebral edema (8%) and cerebral hemorrhage (40%). All patients required transfusions using blood products. There were 11 maternal deaths (30%).

Conclusion: Because of high maternal mortality and morbidity found among patients with HELLP syndrome, standard antenatal follow-up protocols should be applied, so as to obtain early diagnosis and improve the speed of transfer to obstetric departments with expertise in this field.

CONTEXTO E OBJETIVO:: Apesar do desenvolvimento de instalações terciárias de cuidado e tratamento intensivo e de técnicas avançadas de transfusão de sangue, desordens hipertensivas da gravidez são a causa principal de mortalidade materna na maioria dos países. Nosso objetivo foi determinar o resultado materno nas gravidezes complicadas pela síndrome HELLP (hemólise, enzimas hepáticas elevadas e contagem de plaquetas baixa) que exigiram cuidados intensivos.

TIPO DE ESTUDO E LOCAL:: Estudo retrospectivo realizado na Karadeniz Technical University, Department of Obstetrics and Gynecology, and Department of Anaesthesiology and Reanimation, Trabzon, Turquia.

MÉTODOS:: 37 pacientes com a síndrome HELLP admitidas à unidade de cuidado intensivo obstétrico foram analisadas retrospectivamente entre 1992 e 2004.

RESULTADOS:: Todasas pacientes eram hipertensas, com escala Glasgow de coma média de 11 ± 3,96. A idade gestacional média no parto foi de 32 ± 4,09 semanas. O parto foi vaginal em 9 e por cesárea em 27 pacientes. Anestesia geral foi usada em 12 e loco-regional em 25 pacientes. Morbidades maternas incluíram a falência renal aguda (11%), coagulação intravascular disseminada (5%), edema agudo do pulmão (3%), ascite grave (11%), o derrame pleural (3%), síndrome respiratória aguda grave (11%), descolamento prematuro de placenta (11%), edema cerebral (8%) e hemorragia cerebral (40%). Todas as pacientes necessitaram de transfusão de produtos do sangue. Ocorreram 11 (30%) mortes maternas.

CONCLUSÕES:: Devido à alta morbidade e mortalidade maternas encontradas nas pacientes com síndrome HELLP, protocolos antenatais de acompanhamento devem ser aplicados de modo a se obter diagnóstico precoce e a de apressar a transferência para um departamento obstétrico onde a equipe de profissionais tenha perícia no campo.

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Conflict of interest statement

Conflicts of interest: Not declared

Comment in

  • "Help" with HELLP syndrome.
    Kuczkowski KM. Kuczkowski KM. Sao Paulo Med J. 2007 May 3;125(3):197-8. doi: 10.1590/s1516-31802007000300014. Sao Paulo Med J. 2007. PMID: 17923948 Free PMC article. No abstract available.

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