The HELLP syndrome: Clinical issues and management. A Review

Haram, Kjell; Svendsen, Einar; Abildgaard, Ulrich

doi:10.1186/1471-2393-9-8

Cited by 539 publications

(524 citation statements)

References 157 publications

(273 reference statements)

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“…But not in the usual clinical parameter of Blood Pressure that typical reflects disease severity of preeclampsia. This is similar to the findings of Hemant S et al and Heram K et al 6,9 Caesarian Section rate in HELLP was very high in the study as pregnancy was terminated as soon as disease was diagnosed to avoid worsening of condition. This resulted in increased in cesarean section rate and preterm delivery.…”

Section: Methodssupporting

confidence: 92%

Feto-maternal outcome in patients with HELLP and partial HELLP syndrome: a prospective 10 year study in Shri Guru Ram Rai Institute of Medical and Health Sciences, Uttarakhand, India

Tandon¹,

Chaudhari²,

Gupta³

et al. 2016

Int J Reprod Contracept Obstet Gynecol

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Section: Methodssupporting

confidence: 92%

Feto-maternal outcome in patients with HELLP and partial HELLP syndrome: a prospective 10 year study in Shri Guru Ram Rai Institute of Medical and Health Sciences, Uttarakhand, India

Tandon¹,

Chaudhari²,

Gupta³

et al. 2016

Int J Reprod Contracept Obstet Gynecol

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“…There is also debate over the optimal management of the syndrome, particularly with regard to women who develop the condition remote from term. 66,67 Uterine rupture Uterine rupture is a complication of pregnancy associated with severe maternal and fetal morbidity and mortality. In high-income countries it most commonly occurs in women who have previously delivered by caesarean section.…”

Section: Hellp/ellp Syndromementioning

confidence: 99%

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

101

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BackgroundStudies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision.ObjectivesTo (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts.MethodsMixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group.SettingMaternity units in all four countries of the UK.ParticipantsWomen with near-miss maternal morbidities, their partners and comparison women without severe morbidity.Main outcome measuresThe incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches.ResultsWomen and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services.LimitationsThis programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded.ConclusionsImplementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…La segunda posibilidad de actuación seríaa una conducta semi-intervencionista que tenga como objetivo tomar medidas que puedan tener un impacto en la supervivencia y disminución de la morbidad neonatal visto que 80% de los casos ocurren en gestaciones pre-término; esta conducta se basa en el uso de corticoides administrados a la madre con el objetivo de acelerar la maturidade pulmonar fetal, reducir la incidencia de hemorragia intraventricular neonatal y de mejorar la adaptación hemodinámica del recién nacido pre-término; la administración profiláctica de corticoides está indicada entre 24 y 34 semanas de gestación; esta conducta se basa en los estudios relacionados con la administración de corticoides a altas dosis y mejora del cuadro del paciente (1) (2) .…”

Section: Conductaunclassified

“…A pesar de que los análisis de laboratorio son confiables y ampliamente aceptados como indicadores de la instalación del Síndrome Hellp, la sintomatología enmascara las evidencias y no siempre los profesionales reconocen prontamente su presencia; enfermedades como gastritis, apendicitis, cálculos renales, hepatitis, presentan informes clínicos y de laboratorio semejantes y tiende a ser la primera sospecha diagnóstica (2) .…”

Section: Comentariosunclassified

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Síndrome Hellp: estudio de revisión para la atención de enfermería

Tardin

Matos

Silva

et al. 2012

eglobal

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RESUMENRevisión narrativa de enfoque cualitativo que analiza el síndrome HELLP como una de las principales complicaciones de la hipertensión arterial en el embarazo. HELLP significa: H: hemolisis, EL = enzimas hepáticas elevadas y LP: disminución del número de plaquetas circulantes. Cuando una mujer embarazada en estado de pre-eclampsia presenta alteraciones clínicas o de laboratorio compatibles con hemolisis, se puede considerar la posibilidad de síndrome de HELLP. Cuando el cuadro materno es estable es posible seguir el embarazo con la utilización de corticoides en la inducción de la maduración del pulmón fetal, con reducción de las complicaciones maternas y neonatales, dado que en el síndrome HELLP la interrupción del embarazo es el único tratamiento capaz de disminuir el síndrome. Este estudio destaca la importancia de la propedéutica investigadora para el diagnóstico del síndrome HELLP cuando embarazadas hipertensas con pre-eclampsia son asistidas por la enfermera en las consultas de prenatal. RESUMORevisão Narrativa de abordagem qualitativa que analisa a Síndrome HELLP como uma das principais complicações da hipertensão arterial na gravidez. A palavra HELLP significa: H: hemólise; EL: enzimas hepáticas elevadas e LP: diminuição do número de plaquetas circulantes. Quando uma gestante em estado de pré-eclampsia apresenta alterações laboratoriais ou clínicas compatíveis com hemólise, pode-se considerar a possibilidade da Síndrome HELLP. Quando o quadro materno apresenta-se estável é possível viabilizar a gestação a partir do uso de corticóides na indução da maturação pulmonar fetal, com redução das complicações maternas e neonatais; até porque na Síndrome HELLP o término da gestação é o único tratamento capaz de frear a Síndrome. Este estudo destaca a importância da propedêutica investigante para o diagnostico da Síndrome HELLP sempre que uma

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The HELLP syndrome: Clinical issues and management. A Review

Cited by 539 publications

References 157 publications

Feto-maternal outcome in patients with HELLP and partial HELLP syndrome: a prospective 10 year study in Shri Guru Ram Rai Institute of Medical and Health Sciences, Uttarakhand, India

Feto-maternal outcome in patients with HELLP and partial HELLP syndrome: a prospective 10 year study in Shri Guru Ram Rai Institute of Medical and Health Sciences, Uttarakhand, India

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Síndrome Hellp: estudio de revisión para la atención de enfermería

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