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HELLP-syndrome as a life-threatening condition: current clinical considerations

https://doi.org/10.17749/2313-7347.2019.13.1.035-042

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Abstract

HELLP-syndrome is an extremely serious complication of pregnancy with a high risk of adverse perinatal and maternal outcomes. Aim: to study the clinical course, maternal and perinatal complications in pregnant women with HELLP-syndrome. Materials and methods. We conducted a retrospective study on clinical records of 28 births by women with HELLP-syndrome and 35 women with severe preeclampsia (PE) without HELLP-syndrome manifestations. The diagnostic criteria of the HELLP-syndrome in patients with severe РЕ were based on the symptoms of intravascular hemolysis typically manifested in arterial hypertension, proteinuria, and generalized edema. Results. The classical three symptoms of HELLP-syndrome were noted only in 64.2 % of cases, and the mono-symptomatic course - in 35.7 % of cases. The total triad of HELLP-syndrome (hemolysis, thrombocytopenia, elevation of hepatic enzymes) was recorded in 42.8 % of cases. The most common form was the typical HELLP-syndrome, then - the ELLP-syndrome (elevation of liver enzymes and thrombocytopenia) - 57.2 % of cases; an isolated elevation of hepatic enzymes in severe PE was found in 53.5 % of cases, thrombocytopenia in severe PE - in 64.2 % of cases. A high incidence of adverse perinatal outcomes was also found: premature births (64.2 %) and antenatal fetal death (21.4 %). Conclusion. In the above clinical situations, the diagnostic judgement should be pointed towards the HELLP-syndrome; accordingly, the adequate obstetric management should be initiated to prevent the development of life-threatening complications in both the mother and the fetus.

About the Authors

E. V. Timokhina
I.M. Sechenov First Moscow State Medical University, Health Ministry of Russian Federation
Russian Federation

Elena V. Timokhina - MD, PhD, Professor, Department of Obstetrics and Gynecology, Faculty of General and Preventive Medicine, I.M. Sechenov First MSMU HM of RF.

8/2 Trubetskaya St., Moscow 119991.

Tel.: +7(499)7823045.

Scopus Author ID: 25958373500



A. N. Strizhakov
I.M. Sechenov First Moscow State Medical University, Health Ministry of Russian Federation
Russian Federation

Alexander N. Strizhakov - MD, PhD, Professor, Academician of RAS, Head of Department of Obstetrics and Gynecology, Faculty of General and Preventive Medicine, I.M. Sechenov First MSMU HM of RF.

8/2 Trubetskaya St., Moscow 119991.

Scopus Author ID: 7005104683



V. S. Belousova
I.M. Sechenov First Moscow State Medical University, Health Ministry of Russian Federation
Russian Federation

Vera S. Belousova - PhD, Associate Professor, Department of Obstetrics, Gynecology and Perinatology, Faculty of General and Preventive Medicine, I.M. Sechenov First MSMU HM of RF.

8/2 Trubetskaya St., Moscow 119991.

Tel.: +7(499)7823045.



A. G. Aslanov
I.M. Sechenov First Moscow State Medical University, Health Ministry of Russian Federation
Russian Federation

Alexander G. Aslanov - PhD, Associate Professor, Department of Obstetrics, Gynecology and Perinatology, Faculty of General and Preventive Medicine, I.M. Sechenov First MSMU HM of RF.

8/2 Trubetskaya St., Moscow 119991.

Tel.: +7(499)7823045.



I. M. Bogomazova
I.M. Sechenov First Moscow State Medical University, Health Ministry of Russian Federation
Russian Federation

Irina M. Bogomazova - PhD, Associate Professor, Department of Obstetrics, Gynecology and Perinatology, Faculty of General and Preventive Medicine, I.M. Sechenov First MSMU HM of RF.

8/2 Trubetskaya St., Moscow 119991.

Tel.: +7(499)7823045.



N. V. Afanasyeva
City Clinical Hospital named after S.S. Yudin, Moscow Healthcare Department
Russian Federation

Natalya V. Afanasyeva - PhD, Deputy Chief Physician for Obstetrics and Gynecology, CCH n.a. S.S. Yudin, Moscow Healthcare Department.

4 Kolomenskiy passage, Moscow 115446.



Ju. A. Samoylova
City Clinical Hospital named after S.S. Yudin, Moscow Healthcare Department
Russian Federation

Julia A. Samoylova - PhD, Head of Department of Pregnancy Pathology, CCH n.a. S.S. Yudin, Moscow Healthcare Department.

4 Kolomenskiy passage, Moscow 115446.



S. M. Ibragimova
I.M. Sechenov First Moscow State Medical University, Health Ministry of Russian Federation
Russian Federation

Sapiyat M. Ibragimova - Postgraduate Student, Department of Obstetrics, Gynecology and Perinatology, Faculty of General and Preventive Medicine, I.M. Sechenov First MSMU HM of RF.

8/2 Trubetskaya St., Moscow 119991.

Tel.: +7(499)7823045.



A. M. Kechina
I.M. Sechenov First Moscow State Medical University, Health Ministry of Russian Federation
Russian Federation

Anna M. Kechina - Medical Student, I.M. Sechenov First MSMU HM of RF.

8/2 Trubetskaya St., Moscow 119991.

Tel.: +7(499)7823045.



References

1. Makatsariya A.D., Chervenak F.A., Bitsadze V.O. Pregnancy of high risk. [Beremennost' vysokogo riska]. Moskva: MIA, 2015. 920 s. (In Russ.).

2. Aloizos S., Seretis C. Liakos N. et al. HELLP-syndrome: understanding and management of a pregnancy-specific disease. J Obstet Gynaecol. 2013;33(4):331-7.

3. Fedyunina I.A. Fetoplacental complex and perinatal outcomes in pregnant women with impaired hepatic function. [Sostoyanie fetoplacentarnogo kompleksa i perinatal'nye iskhody u beremennyh s narusheniyami funkcii pecheni]. Avtoref. dis. kand. med. nauk. Moskva, 2018. 24 s. (In Russ.).

4. Makatsariya A.D., Bitsadze V.O., Khizroeva D.X., Akinshina S.B. Thrombotic microangiopathies in obstetric practice. [Tromboticheskie mikroangiopatii v akusherskoj praktike]. Moskva: GEOTAR-Media, 2017. 304 s. (In Russ.).

5. O'Brien J.M., Barton J.R. Controversies with the diagnosis and management of HELLP-syndrome. Clin Obstet Gynecol. 2005;48(2):460-77.

6. Hypertensive disorders during pregnancy, during childbirth and the postpartum period. Preeclampsia. Eclampsia. Clinical recommendations (protocol of treatment). Russian Society of Obstetricians and Gynecologists. [Gipertenzivnye rasstrojstva vo vremya beremennosti, v rodah i poslerodovom periode. Preeklampsiya. Eklampsiya. Klinicheskie rekomendacii (protokol lecheniya). Rossijskoe obshchestvo akusherov-ginekologov]. Utv. MZ RF 16 maya 2016 (Pis'mo MZ RF № 15-4/10/2-3483). Moskva, 2016. 40 s. (In Russ.). Accessed: http://www.rokb.ru/sites/default/files/pictures/gipertenzivnye_rasstroystva_vo_vremya_beremennosti_v_rodah_i_poslerodovom_periode._preeklampsiya._eklampsiya.pdf.

7. Audibert F., Friedman S.A., Frangieh A.Y., Sibai B.M. Clinical utility of strict diagnostic criteria for the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Am J Obstet Gynecol. 1996;175(2):460-4.

8. Committee Opinion No 671: Perinatal risks associated with assisted reproductive technology. American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice, Committee on Genetics, U.S. Food and Drug Administration. Obstet Gynecol. 2016;128(3):e61-8. DOI: 10.1097/AOG.0000000000001643.

9. Watanabe N., Fujiwara T., Suzuki T. et al. Is in vitro fertilization associated with preeclampsia? A propensity score matched study. BMC Pregnancy Childbirth. 2014;14:69. DOI: 10.1186/1471-2393-14-69.

10. Dizon-Townson D., Miller C., Sibai B. et al. The relationship of the factor V Leiden mutation and pregnancy outcomes for mother and fetus. Obstet Gynecol. 2005;106(3):517-24.

11. Said J.M., Higgins J.R., Moses E.K. et al. Inherited thrombophilia polymorphisms and pregnancy outcomes in nulliparous women. Obstet Gynecol. 2010;115(1):5-13.

12. Milne F., Redman C., Walker J. et al. The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community. BMJ. 2005;330(7491):576-80.

13. Le Fevre M.L. U.S. Preventive Services Task Force Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161(11):819-26.

14. Sibai B.M. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 2004;103(5 Pt 1):981-91.

15. Barton J.R., Riely C.A., Adamec Т.А. et al. Hepatic histopathologic condition does not correlate with laboratory abnormalities in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count. Am J Obstet Gynecol. 1992;167(6):1538-43.

16. Makatsariya A.D., Bitsadze V.O., Khizroeva J.Kh. HELLP-syndrome. [HELLP-sindrom]. Akusherstvo, ginekologiya ireprodukciya. 2014;8(2):61-8. (In Russ.).

17. Altamura C., Vasapollo B., Tibuzzi F. et al. Postpartum cerebellar infarction and haemolysis, elevated liver enzymes, low platelet (HELLP) syndrome. ZNeurolSci. 2005;26(1):40-2.


For citation:


Timokhina E.V., Strizhakov A.N., Belousova V.S., Aslanov A.G., Bogomazova I.M., Afanasyeva N.V., Samoylova J.A., Ibragimova S.M., Kechina A.M. HELLP-syndrome as a life-threatening condition: current clinical considerations. Obstetrics, Gynecology and Reproduction. 2019;13(1):35-42. (In Russ.) https://doi.org/10.17749/2313-7347.2019.13.1.035-042

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ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)