enzimas hepáticas elevadas y plaquetopenia)
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
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.
Am Fam Physician 1999 Sep 1;60(3):829-36, 839 [Texto completo]
HELLP syndrome: recognition and perinatal management.
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.
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.
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.
Clin Obstet Gynecol 1999 Jun;42(2):381-9
Egerman RS, Sibai BM
Department of Obstetrics and Gynecology, University of Tennessee, Memphis 38103,
Curr Opin Obstet Gynecol 1999 Apr;11(2):149-56
Management of pre-eclampsia and haemolysis, elevated liver enzymes, and low
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
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]
Institut fur Anaesthesiologie, Ludwig-Maximilians-Universitat Munchen.
Am J Med 1994 Jan 17;96(1A):18S-22S
Hepatic disease in pregnancy.
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.