Long-term maternal and subsequent pregnancy outcomes 5 years after hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome

Habli, Mounira; Eftekhari, N; Wiebracht, Emily; Bombrys, Annette; Khabbaz, Maram; How, Helen; Sibai, Bahaeddine M

doi:10.1016/j.ajog.2009.06.033

Cited by 127 publications

(52 citation statements)

References 21 publications

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“…2 Among the more serious maternal morbidities associated with HELLP syndrome are neurological complications such as eclampsia, brain edema, headaches, visual disturbances, cerebellar infarctions, and cognitive disturbances. [3][4][5] Impairments or disruption in the blood-brain barrier (BBB) can enhance the passage of damaging circulating proteins and water into the brain parenchyma, thereby possibly contributing to the neurological complications that can occur in women with HELLP syndrome. [6][7][8] Previous studies by our group and others have shown that circulating factors in women with preeclampsia and eclampsia are associated with increased permeability of the BBB.…”

Section: Introductionmentioning

confidence: 99%

Plasma From Patients With HELLP Syndrome Increases Blood—Brain Barrier Permeability

et al. 2015

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Circulating inflammatory factors and endothelial dysfunction have been proposed to contribute to the pathophysiology of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. To date, the occurrence of neurological complications in these women has been reported, but few studies have examined whether impairment in blood-brain barrier (BBB) permeability or cerebrovascular reactivity is present in women having HELLP syndrome. We hypothesized that plasma from women with HELLP syndrome causes increased BBB permeability and cerebrovascular dysfunction. Posterior cerebral arteries from female nonpregnant rats were perfused with 20% serum from women with normal pregnancies (n ¼ 5) or women with HELLP syndrome (n ¼ 5), and BBB permeability and vascular reactivity were compared. Plasma from women with HELLP syndrome increased BBB permeability while not changing myogenic tone and reactivity to pressure. Addition of the nitric oxide (NO) synthase inhibitor N o -nitro-L-arginine methyl ester caused constriction of arteries that was not different with the different plasmas nor was dilation to the NO donor sodium nitroprusside different between the 2 groups. However, dilation to the smalland intermediate-conductance, calcium-activated potassium channel activator NS309 was decreased in vessels exposed to HELLP plasma. Thus, increased BBB permeability in response to HELLP plasma was associated with selective endothelial dysfunction.

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Section: Introductionmentioning

confidence: 99%

Plasma From Patients With HELLP Syndrome Increases Blood—Brain Barrier Permeability

et al. 2015

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“…It is now regarded as a metamorphosis of severe preeclampsia or a complication occurring in 5-10 per thousand pregnancies and in 10-20% of cases with severe preeclampsia [11][12][13][14][15][16][17][18] , which poses high risk to maternal and fetal morbidity or mortality as well as long-term depression and chronic hypertension [10][11][12][13][14][15][16][17][18][19][20][21] 12 . In general, conservative treatments are recommended to these patients for controlling BP to the safety level and for promoting the overall situations of the patients to better.…”

Section: Discussionmentioning

confidence: 99%

Pesando riscos e benefícios: lições aprendidas com as intervenções terapêuticas de um caso com pré-eclâmpsia grave

Xu¹,

Shen²,

Fuzhou³

2013

Rev. Bras. Anestesiol.

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Background and objective: Preeclampsia is a multiple organ dysfunction syndrome (MODS) for its typical and atypical manifestations including hypertension, proteinuria, HELLP syndrome, hypertensive encephalopathy and coagulopathy. Optimal management for such patients is determined from an assessment of the balance between benefi ts and risks of anesthetic and obstetric therapeutic strategies. Case Report: A 35-year-old pregnant woman, with one past uncomplicated pregnancy presented at 29 weeks to our medical institute as an emergency with dizziness, chest distress, palpitation, blurred vision and vaginal bleeding. After physical examination and laboratory tests, the patient was diagnosed with severe preeclampsia, HELLP syndrome, placental abruption, and MODS. The patient also presented spinal and pelvic deformity, fi xation of articulus mandibularis, and tracheal displacement because of a traffi c accident 11 years ago. Therefore, urgent cesarean section was performed under general anesthesia with nasal tracheal intubation using a guide wire. The patient was discharged directly home from the obstetric intensive care unit on the 7 th postoperative day with normal blood pressure and full recovery of organic function. Conclusions: This case merits further discussion on the anesthesia considerations concerning how to make a clinical decision when treating such a patient. Neuraxial block is the fi rst choice for preeclampsia patients undergoing cesarean section when a moderate but not progressive thrombocytopenia exists. When general anesthesia is decided, adequate sedation and analgesia is needed to better control the stress response to intubation especially in patients with neurological signs, and to prevent major cerebral complications.

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“…Bununla birlikte rekürrens çoğunlukla parsiyel HELLP sendromlu vakalarda %24-24 olarak raporlanmıştır 29,71 .…”

Section: Sonraki Gebeliklerde Rekürrensunclassified

“…HELLP sendromu hikayesi olan bir kadın sonraki gebeliğinde preeklampsi geliştirme açısından yüksek risk altındadır 68,69,71 . 152 HELLP sendromu hikayesi olan kadının ele alındığı bir çalışmada 212 takip eden gebelikte normotansif kadınların %19'unda, altta yatan hipertansiyon hikayesi olan hastaların %75'inde preeklamsi gelişmiştir 68 .…”

Section: Sonraki Gebeliklerde Rekürrensunclassified

HELLP sendromu

ACAR¹,

ÇETİNDAĞ²,

ALKILIÇ³

et al. 2014

Arşiv Kaynak Tarama Dergisi

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1Ankara Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabulum Dalı, Ankara, Turkey ÖZET HELLP sendromu intravasküler hemoliz, karaciğer enzim yüksekliği ve trombosit düşüklüğü durumu olarak tanımlanmaktadır. %0,1ile %0,8 oranında bir insidansı mevcuttur. Genetik yatkınlık durumunda risk artmaktadır. Ayrıca preeklampsinin aksine multipartite riski artıran bir durumdur. Tanısı HELLP sendromu tanımında da yer alan değerlerdeki değişimlerle konulmaktadır. Özellikle trombosit sayısı sınıflamalarda da kullanılmaktadır. Ayırıcı tanıda akılda bulunması gereken durumlar şiddetli preeklampsi, gebeliğin akut yağlı karaciğeri, hemolitik üremik sendrom, trombotik trombositopenik purpura durumlar ile ayırıcı tanısı yapılması gerekmektedir. Maternal olarak disemine intravasküler koagülasyon (DIC), plasenta dekolmanı, akut renal yetmezlik, pulmoner ödem, subkapsüler karaciğer hematomu, retina dekolmanı gibi komplikasyonlar ile karşılaşabiliriz. Tedavide ise şu an için önerilen hastanın stabilizasyonu, kan basıncı kontrolü ve magnezyum sülfat infüzyonu başlanması önerilmektedir. Daha sonra ise fetal hafta, fetal distress ve maternal distress açısından değerlendirilerek bu risklerin olması durumunda doğum düşünülmelidir. Eğer risk faktörleri negatif ve fetus 24 ile 34 hafta arasında ise steroid dozu tamamlanıp devamında doğum planlanmalıdır. Sonuç olarak HELLP sendromunun kesin tedavisi doğumdur. Steroid tedavisi ve diğer tedavi seçenekleri ile ilgili geniş randomize çalışmalara ihtiyaç vardır. Anahtar kelimeler: HELLP sendromu, tanı, sınıflama, komplikasyon, tedavi ABSTRACT HELLP syndrome is characterized by hemolysis, elevated liver enzymes and thrombocytopenia. With anincidence of 0.1%-0.8% it is known to be effected by genetic predisposition. Unlike preeclempsia multiparity increases the risk of HELLP syndrome. Diagnosis is made by the classic clinical triad. Thrombocyte counts are especially important for classification of the disease. When making a

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Long-term maternal and subsequent pregnancy outcomes 5 years after hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome

Cited by 127 publications

References 21 publications

Plasma From Patients With HELLP Syndrome Increases Blood—Brain Barrier Permeability

Plasma From Patients With HELLP Syndrome Increases Blood—Brain Barrier Permeability

Pesando riscos e benefícios: lições aprendidas com as intervenções terapêuticas de um caso com pré-eclâmpsia grave

HELLP sendromu

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