LA CONSULTA SEMANAL

JULIO 2000

CONSULTA

Am J Obstet Gynecol 2000 May;182(5):1271 [Texto completo] 
HELLP (hemolysis, elevated liver enzymes, and low platelets) needs help. 
Hohlagschwandtner M, Bancher-Todesca D, Strohmer H 
Publication Types: 
Letter 

J Perinatol 1999 Mar;19(2):138-43 
A review of HELLP syndrome. 
Curtin WM, Weinstein L 
Department of Obstetrics and Gynecology, Medical College of Ohio, Toledo 43614-5809, USA. 
HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is a variant of severe preeclampsia which is associated with substantial maternal and perinatal morbidity and mortality. As with preeclampsia, the etiology and pathogenesis of HELLP syndrome is not completely understood. An increase in vascular thrombosis and activation of the coagulation system may be important in the clinical presentation of this disorder. Laboratory criteria for the diagnosis of HELLP syndrome have been classically described but lack uniformity among different institutions. Aggressive management of HELLP syndrome with expeditious delivery appears to yield the lowest perinatal mortality rates. Conservative or expectant management has been associated with higher stillbirth rates with antenatal corticosteroids not causing resolution of the laboratory abnormalities. Resolution of laboratory abnormalities in HELLP syndrome runs a protracted course over several days after delivery. Despite nearly two decades since HELLP syndrome has been defined as a clinical entity, treatment for the disorder still remains delivery of the patient. 
Publication Types: 
Review 
Review, tutorial 

Am Fam Physician 1999 Sep 1;60(3):829-36, 839 [Texto completo] 
HELLP syndrome: recognition and perinatal management. 
Padden MO 
Naval Hospital, Camp Pendleton, California 92055, USA. 
HELLP, a syndrome characterized by hemolysis, elevated liver enzyme levels and a low platelet count, is an obstetric complication that is frequently misdiagnosed at initial presentation. Many investigators consider the syndrome to be a variant of preeclampsia, but it may be a separate entity. The pathogenesis of HELLP syndrome remains unclear. Early diagnosis is critical because the morbidity and mortality rates associated with the syndrome have been reported to be as high as 25 percent. Platelet count appears to be the most reliable indicator of the presence of HELLP syndrome. The D-dimer test may be a useful tool for the early identification of patients with preeclampsia who may develop severe HELLP syndrome. The mainstay of therapy is supportive management, including seizure prophylaxis and blood pressure control in patients with hypertension. Women remote from term should be considered for conservative management, whereas those at term should be delivered. Some patients require transfusion of blood products, and most benefit from corticosteroid therapy. Rarely, patients with refractory HELLP syndrome require plasmapheresis. 
Publication Types: 
Review 
Review, tutorial 

Clin Obstet Gynecol 1999 Sep;42(3):532-50 
Twelve steps to optimal management of HELLP syndrome. 
Magann EF, Martin JN Jr 
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA. 
The early diagnosis and treatment of HELLP syndrome remains problematic for the obstetric health care provider. The nonspecific signs and symptoms of this disorder early in the disease process make the accurate diagnosis difficult and delays early treatment, which has the best prognosis for both maternal and 
perinatal outcome. The introduction of high-dose nonmineralocorticosteriods to assist in the treatment of these patients is an exciting new development. Use of the 12-step approach to the diagnosis and management of pregnancies complicated by HELLP syndrome has proven to be a successful tool to help us achieve the best possible maternal and perinatal outcome. 
Publication Types: 
Review 
Review, tutorial 

Hosp Med 1999 Apr;60(4):243-9 
HELLP syndrome: mechanisms and management. 
Ellison J, Sattar N, Greer I 
University Department of Obstetrics and Gynaecology, Glasgow Royal Infirmary University NHS Trust. 
Effective management of HELLP syndrome depends on swift recognition of a condition which often masquerades as other pathology. This article reviews clinical aspects of HELLP syndrome and outlines recent advances in our comprehension of what may be the underlying pathophysiology. 
Publication Types: 
Review 
Review, tutorial 

Clin Obstet Gynecol 1999 Jun;42(2):381-9 
HELLP syndrome. 
Egerman RS, Sibai BM 
Department of Obstetrics and Gynecology, University of Tennessee, Memphis 38103, USA. 
Publication Types: 
Review 
Review, tutorial 


Curr Opin Obstet Gynecol 1999 Apr;11(2):149-56 
Management of pre-eclampsia and haemolysis, elevated liver enzymes, and low platelets syndrome. 
Anumba DO, Robson SC 
Department of Obstetrics and Gynaecology, The Royal Victoria Infirmary, Newcastle upon Tyne, UK. 

Pre-eclampsia remains a major cause of maternal and fetal ill-health. Defective placentation and endothelial dysfunction appear to underlie the clinical features. Recent publications regarding the diagnosis, treatment, prediction and prevention of pre-eclampsia, and contemporary issues in the management of the haemolysis, elevated liver enzymes, and low platelets syndrome, are discussed in this review. 
Publication Types: 
Review 
Review, tutorial 

Anaesthesist 1997 Aug;46(8):732-47 
Published erratum appears in Anaesthesist 1997 Sep;46(9):826 
[Gestosis and the HELLP-syndrome]. 
[Article in German] 
Frey L 
Institut fur Anaesthesiologie, Ludwig-Maximilians-Universitat Munchen. 
Publication Types: 
Review 
Review, tutorial 

Am J Med 1994 Jan 17;96(1A):18S-22S 
Hepatic disease in pregnancy. 
Riely CA 
Department of Medicine, University of Tennessee, Memphis 38163. 
Liver disease occurring in pregnancy can be categorized into three groups. The first group includes diseases unique to pregnancy and caused by it. Among these are hyperemesis gravidarum, cholestasis of pregnancy, and disorders associated with preeclampsia. Liver involvement may be expected in 50% of patients with hyperemesis gravidarum. Preeclampsia has been associated with both the HELLP syndrome (hemolysis, elevated liver tests, and low platelets), which includes hepatic infarction and rupture, and with acute fatty liver of pregnancy (AFLP). In patients with HELLP syndrome, liver test abnormalities do not correlate with liver injury. Therefore, this and other disorders associated with preeclampsia require aggressive treatment, primarily with delivery. The second group of liver diseases are those exacerbated by pregnancy. Viral infections involving the liver that are usually benign, such as hepatitis E and herpes simplex, are more likely to be exacerbated in pregnant women and are more likely to lead to fulminant hepatic failure. Cholelithiasis and Budd-Chiari syndrome are more prevalent in pregnant women. The third group is comprised of liver diseases that are preexisting in the pregnant patient and includes autoimmune chronic active hepatitis and Wilson's disease. The number of patients in the last group is small, as chronic liver disease is rare in women who are able to bear children. 
Publication Types: 
Review 
Review, tutorial