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[The HELLP syndrome. Notes on its pathogenesis and treatment].
Minerva Ginecol. 1996 Apr; 48(4):147-54.MG

Abstract

In 1982 Weinstein coined the term HELLP syndrome to describe a special group of pre-eclamptic women who had evidence of hemolysis, elevated liver enzymes and low platelets. The question of whether the HELLP syndrome exists as a distinct entity or is a part of a spectrum of pregnancy complications has long been a source of speculation and debate among obstetricians and internists. A review of the literature indicates that the syndrome occurs in post-partum from 20% to 30% of the cases; maternal mortality from 1% to 4% and perinatal mortality from 5% to 40%. Hypertension and proteinuria are frequently associated with HELLP syndrome, but may also be absent. The syndrome is a group of clinical and pathological manifestations resulting from an insult that leads to intravascular platelet activation (thrombocytopenia) and micro-angiopathic hemolytic anemia (elevated total bilirubin and LDH). Endothelial damage and vasospasm are responsible of hepatic hypoperfusion that results in liver damage, as indicated by a rise in circulating liver enzymes. Since natural evolution of HELLP syndrome is the disseminated intravascular coagulation (CID), the interruption of pregnancy is mandatory and irrespective of the gestational age. This is the reason of an high incidence of cesarean section. Visser and Wallemburg (1995) treated 128 pre-eclamptic patients with HELLP syndrome with volume expansion and pharmacologic vasodilatation under invasive haemodynamic monitoring; they tried to delay delivery with the aim of enhancing fetal maturity. A complete reversal of HELLP occurred in 43% of patients. Further investigations will be necessary to confirm this interesting experience.

Authors+Show Affiliations

Istituto di Ginecologia, Università degli Studi, Messina.

Pub Type(s)

English Abstract
Journal Article
Review

Language

ita

PubMed ID

8767557

Citation

D'Anna, R. "[The HELLP Syndrome. Notes On Its Pathogenesis and Treatment]." Minerva Ginecologica, vol. 48, no. 4, 1996, pp. 147-54.
D'Anna R. [The HELLP syndrome. Notes on its pathogenesis and treatment]. Minerva Ginecol. 1996;48(4):147-54.
D'Anna, R. (1996). [The HELLP syndrome. Notes on its pathogenesis and treatment]. Minerva Ginecologica, 48(4), 147-54.
D'Anna R. [The HELLP Syndrome. Notes On Its Pathogenesis and Treatment]. Minerva Ginecol. 1996;48(4):147-54. PubMed PMID: 8767557.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [The HELLP syndrome. Notes on its pathogenesis and treatment]. A1 - D'Anna,R, PY - 1996/4/1/pubmed PY - 1996/4/1/medline PY - 1996/4/1/entrez SP - 147 EP - 54 JF - Minerva ginecologica JO - Minerva Ginecol VL - 48 IS - 4 N2 - In 1982 Weinstein coined the term HELLP syndrome to describe a special group of pre-eclamptic women who had evidence of hemolysis, elevated liver enzymes and low platelets. The question of whether the HELLP syndrome exists as a distinct entity or is a part of a spectrum of pregnancy complications has long been a source of speculation and debate among obstetricians and internists. A review of the literature indicates that the syndrome occurs in post-partum from 20% to 30% of the cases; maternal mortality from 1% to 4% and perinatal mortality from 5% to 40%. Hypertension and proteinuria are frequently associated with HELLP syndrome, but may also be absent. The syndrome is a group of clinical and pathological manifestations resulting from an insult that leads to intravascular platelet activation (thrombocytopenia) and micro-angiopathic hemolytic anemia (elevated total bilirubin and LDH). Endothelial damage and vasospasm are responsible of hepatic hypoperfusion that results in liver damage, as indicated by a rise in circulating liver enzymes. Since natural evolution of HELLP syndrome is the disseminated intravascular coagulation (CID), the interruption of pregnancy is mandatory and irrespective of the gestational age. This is the reason of an high incidence of cesarean section. Visser and Wallemburg (1995) treated 128 pre-eclamptic patients with HELLP syndrome with volume expansion and pharmacologic vasodilatation under invasive haemodynamic monitoring; they tried to delay delivery with the aim of enhancing fetal maturity. A complete reversal of HELLP occurred in 43% of patients. Further investigations will be necessary to confirm this interesting experience. SN - 0026-4784 UR - https://www.unboundmedicine.com/medline/citation/8767557/[The_HELLP_syndrome__Notes_on_its_pathogenesis_and_treatment]_ L2 - http://www.diseaseinfosearch.org/result/3266 DB - PRIME DP - Unbound Medicine ER -
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