Sindrome HELLP: peor pronóstico en los trastornos hipertensivos del embarazo.
[Sindrome HELLP: peor pronóstico en los trastornos hipertensivos del embarazo.]Paulino Vigil-De Gracia1
1. MSPOG ACOG CAJA DE SEGURO SOCIAL.
Descargas
Resumen
Los trastornos o desordenes hipertensivos del embarazo (THE) son un grupo de complicaciones asociadas al embarazo y se dividen en pre-eclampsia, eclampsia, hipertensión gestacional, hipertensión crónica y pre-eclampsia agregada. En América Latina y el Caribe son la principal causa de muerte materna. La convulsión (eclampsia) en un trastorno hipertensivo del embarazo es considerada como la complicación con mayor riesgo de muerte materna y complicaciones perinatales. Existe una complicación de los THE conocida como síndrome HELLP que genera alta morbilidad y mortalidad materna. Nuestros hallazgos sugieren cambiar el paradigma de que la eclampsia es la complicación de peor pronóstico dentro de los THE, pues existen mucha mayor morbilidad y mortalidad con la presencia de síndrome HELLP las cuales empeora si el síndrome HELLP se complica con eclampsia.
Abstract
Hypertensive disorders of pregnancy (HDP) are a group of pregnancy-related complications and are divided into pre-eclampsia, eclampsia, gestational hypertension, chronic hypertension and aggregate pre-eclampsia. In Latin America and the Caribbean is the leading cause of maternal death. The seizure (eclampsia) is considered the most at risk of maternal death and perinatal complications. HELLP syndrome is a complication of HDP with high maternal morbidity and mortality. Our findings suggest a paradigm shift that eclampsia is a complication of poor outcome within DHP, because there are much higher morbidity and mortality in the presence of HELLP syndrome, however eclampsia with HELLP syndrome is considerate of high risk to maternal mortality.
Key words: HELLP Syndrome, gestational hypertension, outcomes, eclampsia, pre-clampsia, maternal mortality, seizures.
Abstract
Los trastornos o desordenes hipertensivos del embarazo (THE) son un grupo de complicaciones asociadas al embarazo y se dividen en pre-eclampsia, eclampsia, hipertensión gestacional, hipertensión crónica y pre-eclampsia agregada. En América Latina y el Caribe son la principal causa de muerte materna. La convulsión (eclampsia) en un trastorno hipertensivo del embarazo es considerada como la complicación con mayor riesgo de muerte materna y complicaciones perinatales. Existe una complicación de los THE conocida como síndrome HELLP que genera alta morbilidad y mortalidad materna. Nuestros hallazgos sugieren cambiar el paradigma de que la eclampsia es la complicación de peor pronóstico dentro de los THE, pues existen mucha mayor morbilidad y mortalidad con la presencia de síndrome HELLP las cuales empeora si el síndrome HELLP se complica con eclampsia.
Abstract
Hypertensive disorders of pregnancy (HDP) are a group of pregnancy-related complications and are divided into pre-eclampsia, eclampsia, gestational hypertension, chronic hypertension and aggregate pre-eclampsia. In Latin America and the Caribbean is the leading cause of maternal death. The seizure (eclampsia) is considered the most at risk of maternal death and perinatal complications. HELLP syndrome is a complication of HDP with high maternal morbidity and mortality. Our findings suggest a paradigm shift that eclampsia is a complication of poor outcome within DHP, because there are much higher morbidity and mortality in the presence of HELLP syndrome, however eclampsia with HELLP syndrome is considerate of high risk to maternal mortality.
Key words: HELLP Syndrome, gestational hypertension, outcomes, eclampsia, pre-clampsia, maternal mortality, seizures.
Citas
[1] - National High Blood Pressure Education Program Working Group Report on high blood pressure in pregnancy. Am J Obstet Gynecol 2000;183:S1-S23..
[2] - The Magpie Trial Collaborative Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomized placebo controlled trial. Lancet 2002;359:1877-90.
[3] - ACOG. Diagnosis and management of preeclampsia and eclampsia. ACOG Practice Bulletin No. 33 American College of Obstetricians and
[4] Gynecologist. Obstet Gynecol 2002;99:159-67.
[5] - Witlin AG, Sibai BM. Hypertension. Clin Obstet Gynecol 1998;41:533
[6] - Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PFA. Who analysis of causes of maternal death: a systematic review. Lancet 2006;367:1066-74.
[7] - VillarJ, Say L, Shennan A, et al. Methodological and technical issues related to the diagnosis, screening, prevention, and treatment of pre-eclampsia and eclampsia. Int J Gynaecol Obstet 2004;85:S28-41.
[8] - Campbell OM, Graham WJ, Lancet maternal survival series steering group. Strategies for reducing maternal mortality: getting on with what Works. Lancet 2006, 368(9543):1284-99.
[9] - NHS. National institute for health and clinical excellence. Hpertension in pregnancy. The management of hypertensive disorders during pregnancy. Issue date: August 2010.
[10] - Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia: Lancet , 2010,21;376(9741)631-44.
[11] - Ciantar E, Walker JJ. Pre-eclampsia, severe pre-eclampsia and hemolysis. Elevated liver enzymes and low platelets síndrome: what is new? Women´s Health, 2011;7(5):555-69.
[12] - Uzan J, Carbonnel M, Piconne O, Asmar R, Ayoubi JM. Pre-eclampsia: pathophysiology, diagnosis, and management. Vasc Health Risk Manag 2011;7:467-74.
[13] - Weinstein L. Síndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hipertensión in pregnancy. Am J Obstet Gynecol 1982;142:159-67.
[14] - Sibai BM. The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): much ado about nothing? Am J Obstet Gynecol 1990;162:311-6.
[15] - Martin JN Jr., Blake PG, Perry Jr. KG, McCaul JF, Hess LW, Martin RW. The natural history of HELLP syndrome: patterns of disease progression and regression. Am J Obstet Gynecol 1991;164:1500-13.
[16] - Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol 2004;103:981-91.
[17] - Vigil-De Gracia P. Pregnancy complicated by pre-eclampsia-eclampsia with HELLP syndrome. Int J Obstet Gynecol 2001;72:17-23.
[18] - Vigil-De Gracia P, Tenorio-Marañón RF, Cejudo-Caranza E, Helguera-Martinez A, García-Cáceres E. Diferencias entre pre-eclampsia, syndrome de HELLP y eclampsia: Evaluación materna. Gin Obstet Mex 1996;64:337-382.
[19] - Audibert F, Friedman SA, Frangieh AY, Sibai BM. Clinical utility of strict criteria for the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Am J Obstet Gynecol 1996;175:460-4.
[20] - Martin JN Jr , Rinehart B, May WL, Magann EF, Terrone DA, Blake PG. The spectrum of severe preeclampsia: comparative analysis by HELLP syndrome classification. Am J Obstet Gynecol 1999;180:1373-84.
[21] - Vigil-De Gracia P. Acute fatty liver and HELLP syndrome: two distinct pregnancy disorders. Int J Gynecol Obstet 2001;73:215-20.
[22] - Martin JN Jr, Thigsen BD, Rose CH, Cushman J, Moore A, May WL. Maternal benefit of high-dose intravenous corticosteroids therapy for HELLP. Am J Obstet Gynecol 2003;189:830-4.
[23] - Vigil-De Gracia P. Addition of platelet transfusions to corticosteroids does not increase the recovery of severe HELLP syndrome. Eur J Obstet Gynecol Rep Biol 2006;128:194-8.
[24] - Van Pampus MG, Wolf H, Ilsen A, Treffers PE. Maternal outcome following temporizing management of the HLLLP syndrome. Hypertens Pregnancy 2000;19:211-20.
[25] - Abramovici D, Friedman SA, Mercer BM, Audibert F, Kao L, Sibai BM. Neonatal outcome in severe preeclampsia at 24 to 36 weeks’ gestation: does HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome matter? Am J Obstet Gynecol 1999;180:221-5.
[26] - Vigil-De Gracia P. Maternal Deaths due to Eclampsia and HELLP syndrome. Int J Obstet Gynecol 2009;104:90-4.
[27] - DI XD, Chen DJ, Liu HS, Kuang JL, Huang DJ. Clinical outcomes and characteristics of concurrent eclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome. Zhonghua Fu Chan Ke Za Zhi. 2010 Oct;45(10):740-4.
[28] - Yildirim G, Gungorduk K, Gul A, Asicioglu O, Sudolmus S, Gungorduk OC, Ceylan Y. HELLP Syndrome: 8 Years of Experience from a Tertiary Referral Center in Western Turkey. Hypertension pregnancy 2012;31(3):316-26.
[29] - Erdemoğlu M, Kuyumcuoğlu U, Kale A, Akdeniz N. Factors affecting maternal and perinatal outcomes in HELLP syndrome: evaluation of 126 cases. Clin Exp Obstet Gynecol. 2010;37(3):213-6.
[30] - Keiser SD, Owens MY, Parrish MR, Cushman JL, Bufkin L, May WL, Martin J. HELLP Syndrome with and without Eclampsia. Am J Perinat 2011;28(3):187-94.
[31] - Martin JN, Owens MY, Keiser SD et al. Standardized Mississippi protocol treatment of 190 patients with HELLP syndrome: Slowing disease progression and preventing new major maternal morbidity. Hyperten Pregnancy 2012: 31(1)79-90.
[32] - Vigil-De Gracia P, Ortega-Paz L. Retinal detachment in assocation
[33] with preeclampsia, eclampsia, and HELLP synrome. Int J Gynecol Obstet
[35] - Vigil-De Gracia P, Ortega Paz L. Preeclampsia/eclampsia and hepatic rupture. Int J Gynecol Obstet 2012:118:186-9
Licencia
Derechos autoriales y de reproducibilidad. La Revista Médica de Panama es un ente académico, sin fines de lucro, que forma parte de la Academia Panameña de Medicina y Cirugía. Sus publicaciones son de tipo acceso gratuito de su contenido para uso individual y académico, sin restricción. Los derechos autoriales de cada artículo son retenidos por sus autores. Al Publicar en la Revista, el autor otorga Licencia permanente, exclusiva, e irrevocable a la Sociedad para la edición del manuscrito, y otorga a la empresa editorial, Infomedic International Licencia de uso de distribución, indexación y comercial exclusiva, permanente e irrevocable de su contenido y para la generación de productos y servicios derivados del mismo. En caso que el autor obtenga la licencia CC BY, el artículo y sus derivados son de libre acceso y distribución.
