You are here

Home » Content

Yoğun Bakım Ünitemizde Sık Rastlanan Obstetrik Sorun: Hellp Sendromu (15 Olgunun Analizi)

The Common Obstetric Problem in our Intensive Care Unit: Hellp Syndrome (Analysis of 15 Cases)

Journal Name:

  • Selçuk Tıp Dergisi

Publication Year:

  • 2011

Key Words:

Keywords (Original Language):

Author NameUniversity of Author
Abstract (2. Language): 
Hellp Syndrome (Hemolysis-Elevated Liver enzymes-Low Platelets)is characterized by hemolysis, elevated liver enzymes and low platelet count, and related with an increased with an increased foetal and maternal mortality. We aimed in this study to evaluate the morbidity and mortality of 15 Hellp syndrome patients who have been admitted to our intensive care unit, between 2005 and 2009 years retrospectively. Patients ICU admission indications, demographic, clinical and obstetric data was noted down; hemoglobin, serum albumin level, prothrombine time ve active partial thromboplastin time, fibrinogen level, thrombocyte number, total bilirubine ve creatinine levels, AST, ALT, lactate dehidroginase (LDH) levels were analysed. Intensive care unit(ICU)admission of Hellp sydrome patients were convulsion, loss of consciousness, airway control, invasive hemodinamic monitorisation, ARDS, intracerebral hemorrhage and respiration insufficiency During 4 day intensive care unit following of our patients, thrombocyte numbers began to increase from third day of admission. But this increament was statistically significant between admission day to ICU and fourth day. Again similarly AST, ALT, LDH, ürea ve creatinine levels began to decreased at third day and decreament was statistically significant as from fourth day(P<0.05). Total bilirubin levels of our patients showed significant decrease as from second day. Ten of the patients needed invasive mechanical ventilation, 3 patients supported noninvasively with total face mask. Plasmapheresis applied to 3 patients because of resistant thrombocytopenia and acute renal failure. Only intracerebral hemorrhage patient was died because of sepsis. As a result, Hellp syndrome is one of the most frequent obstetric problems in ICU and has an increased foetal and maternal mortality. Especially Hellp Syndrome patients with convulsions whose clinics thought to be worse after vaginal delivery or C/S admittance to 3. step ICU may reduce complication rate and decrease mortality and morbidity. Plasmapheresis application may decrease organ insufficiencies in severe and resistant cases and increase clinical achievement .
Bookmark/Search this post with
Abstract (Original Language): 
HELLP sendromu (Hemolysis-Elevated Liver enzymes-Low Platelets)hemoliz, yükselmiş karaciğer enzimleri ve trombosit sayısında azalma ile karakterize, yüksek maternal ve perinatal morbidite ve mortalite ile ilişkili bir tablodur. Biz çalışmamızda 2005-2009 arasında, yoğun bakımımızda takip ettiğimiz, Hellp Sendromlu 15 preeklamptik ve eklamptik hastayı retrospektif olarak inceledik. Hastaların yoğun bakıma alınma nedenleri , demografik, klinik ve obstetrik özellikleri kaydedilmiş,hemoglobin, serum albümin seviyesi, protrombin ve parsiyel tromboplastin zamanı,fibrinojen düzeyi, trombosit sayısı, total bilirubin ve kreatinin değerleri, AST, ALT, laktat dehidrogenaz düzeyleri incelenmiştir. Hellp sendromlu hastaların yoğun bakıma alınma nedenleri ciddi konvülsiyon, şuur kaybı , hava yolu kontrolü, invazif hemodinamik monitorizasyon, ARDS, intraserebral hemoraji ve solunum yetersizliği idi. Hastalarımızın yoğun bakımdaki 4 günlük takibi esnasında trombosit sayısı 3. günden itibaren yükselmeye başladı. Ancak bu yükselme yoğun bakıma kabul günü ile karşılaştırıldığında 4. günde istatistiksel olarak anlamlı idi. Yine benzer olarak AST, ALT, LDH, üre ve kreatinin değerleri 3. günden itibaren düşmeye başlarken 4. günden itibaren düşüş anlamlıydı (P<0.05). Hastalarımızın total bilirubin değerleri ise 2.günden itibaren istatistiksel olarak anlamlı düşüş gösterdi. Hastalardan 10 tanesi invaziv mekanik ventilasyona ihtiyaç göstermiş, 3 hasta ise total yüz maskesi ile noninvaziv olarak solunum desteği almıştır. 3 hastamıza dirençli trombositopeni ve akut böbrek yetmezliği olması üzerine plazmaferez uygulanmıştır. Sadece intraserebral hemoraji geçiren vaka sepsis nedeniyle kaybedilmiştir. Sonuç olarak Hellp Sendromu yoğun bakım ünitelerinde en sık rastlanan obstetrik problemlerden olup, yüksek maternal-fetal morbidite ve mortaliteye sahiptir. Özellikle konvülsiyon geçirmiş Hellp Sendromlu hastalar vajinal doğumdan veya C/S’den sonra klinik sürecin ağırlaşabileceği düşünülerek 3. basamak bir yoğun bakımda takip edilmesi komplikasyon oranını azaltıp morbidite ve mortaliteyi düşürebilecektir. Ciddi ve inatçı vakalarda plazmaferez uygulaması organ yetersizliklerini azaltarak klinik başarıyı artırabilir.
FULL TEXT (PDF): 
PDF icon arastirmax-yogun-bakim-unitemizde-sik-rastlanan-obstetrik-sorun-hellp-sendromu-15-olgunun-analizi.pdf
  • 1
18-23
  • Turkish

REFERENCES

References: 

1. Male DA, Stockwell M, Jankowski S. Management of the
critically ill obstetric patient. Current Obstet Gynecol. 2002;
12:322-7.
2. Vigil-De-Gracia P. Pregnancy complicated by pre-eclampsiaeclampsia with HELLP syndrome. Int J Gynaecol Obstet. 2001;
72: 17-23.
3. Martin JN Jr, Blake PG, Lowry SL, Perry KG, Files JC, Morrison
JC. Pregnancy complicated by preeclampsia-eclampsia with
the syndrome of hemolysis, elevated liver enzymes and low
platelet count: How rapid is postpartum recovery? Obstet
Gynecol. 1990; 76:737-41.
4. Weinstein L. Syndrome of hemolysis, elevated liver enzymes,
and low platelet count: a severe consequence of hypertension
in pregnancy. Am J Obstet Gynecol. 1982; 142:159-67.
5. Sibai BM, Taslimi MM, El Nazer A, Anion E, Mabie BC, Ryan
GM. Maternal-perinatal outcome associated with the syndrome
of hemolysis, elevated liver enzymes, and low plateletsin
severe preeclampsia-eclampsia. Am J Obstct Gynecol. 1986;
155: 501-9.
6. Van Dam PA, Renier M, Baekelandt M, Buytaert P, Uyttenbroeck
F. Disseminated intravascular coagulation and the syndrome of
hemolysis, elevated liver enzymes and low platelets in severe
preeclampsia. Obstet Gynecol.1989; 73(1):97-102.
7. Martin JN Jr, 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. Am J Obstet
Gynecol 1999;180:1373.
8. Hazelgrove JF, Price C, Pappachan VJ, Smith GB. Multicenter
study of obstetric admissions to 14 intensive care units in
southhern England. Crit Care Med 2001;29:770-5.
9. Demirkıran O, Dikmen Y, Utku T, Urkmez S. Critically ill
obstetric patients in the intensive care unit. Int J Obstet
Anesthesia 2003; 12:266-70.
10. Geary M. The HELLP syndrome. Br J Obstet Gynaecol 1997,
104:887-91.
11. Karumanchi SA, Maynard SE, Stillman IE, Epstein FH,
Sukhatme VP. Preeclampsia: a renal perspective. Kidney Int
2005, 67:2101-13.
12. Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman
SA. Maternal morbidity and mortality in 442 pregnancies with
hemolysis, elevated liver enzymes, and low platelets (HELLP
syndrome). Am J Obstet Gynecol 1993, 169:1000-6.
13. Padden MO. HELLP syndrome: recognition and perinatal
management. Am Fam Physician 1999, 60:829-38.
14. Haram K, Svendsen E, Abildgaard U. The HELLP syndrome:
Clinical issues and management. BMC Pregnancy and
Childbirth 2009, 9:8-23.
15. Barton JR, Sibai BM. Diagnosis and management of hemolysis,
elevated liver enzymes, and low platelets syndrome. Clin
Perinatol 2004, 31:807-33.
16. Baxter JK, Weinstein L. HELLP syndrome: the state of the art.
Obstet Gynecol Surv 2004, 59:838-45.
17. Parnas M, Sheiner E, Shoham-Vardi I, Burstein E, Yermiahu
T, Levi I, Holcberg G, Yerushalmi R. Moderate to severe
thrombocytopenia during pregnancy. Eur J Obstet Gynecol
Reprod Biol 2006, 128:163-8.
18. Gilbert TT, Smulian JC, Martin AA, Ananth CV, Scorza W,
Scardella AT. Obstetric admissions to the intensive care
unit: Outcomes and severity of illness. Obstet Gynecol
2003,102:897-903.
19. el-Sohl AA, Grant BJ. A comparison of severity of illness
scoring systems for critically ill obstetric patients. Chest
1996,110:1299-304.
20. Hazelgrove JF, Price C, Pappachan VJ, Smith GB. Multicenter
study of obstetric admissions to 14 intensive care units in
southern England. Crit Care Med 2001, 29:770-5.
21. Scarpinato L. Critically ill obstetric patients: Outcome and
predictability utilizing the SAPS II score in a 314 bed community
hospital. Chest 1995, 108:184S.
22. Sibai BM. Diagnosis, controversies, and management of the
syndrome of hemolysis, elevated liver enzymes, and low
platelet count. Obstet Gynecol 2004, 103:981-91.
23. Martin JNJ, Blake PG, Perry KGJ, McCaul JF, Hess LW, Martin
RW: The natural history of Hellp syndrome: patterns of disease
progression and regression. Am J Obstet Gynecol 1991;
164:1500-9.
24. Sibai BM, Ramadan KM. Acute renal failure in pregnancies
comp licated by hemolysis, elevated liver enzymes, and low
platelets. Am J Obstct Gynecol 1993;168: 1682-90. 25. Sibai BM, Villar MA, Mabie BC. Acute renal failure in
hypertansion ve disorders of pregnancy. Pregnancy outcome
and remote progno sis in thirty-one consecutive cases. Am J
Obstet Gynecol 1990; 162: 7777-83.
26. Eser B, Güven M, Ünal A, Coşkun R, Altuntaş F, et al. The
role of plasma exchange in HELLP Syndrome. Clin Appl
Thrombosis/Hemostasis. 2005; 11(2):211-7.
27. Forster JG, Peltonen S, Kaaja R, Lampinen K, Pettilc V.
Plasma exchange in severe postpartum HELLP syndrome. Acta
Anaesthesiol Scand 2002;46(8):955-8.
28. Hamada S, Takishita Y, Tamura T, Naka O, Higuchi K, Takahashi
H. Plasma Exchange in a patient with postpartum HELLP
syndrome. J Obstet Gynaecol Res 1996;22(4):371-4.

Thank you for copying data from http://www.arastirmax.com