Učinak rane dijagnoze i ishodi liječenja rodilja i fetusa u bolesnica sa sindromom HELLP

Background: HELLP syndrome, a severe form of preeclampsia clinically characterized by hemolysis, elevated liver enzymes, and low platelet count, was first described in 1982. Materials and Methods: To assess the impact of recognition of this syndrome on fetal and maternal outcomes, we conducted a retrospective study and reviewed the records of patients with preeclampsia treated at Mayo Clinic before and after 1982. We made a retrospective diagnosis of HELLP in 11 of 146 patients treated for preeclampsia prior to 1982. We compared pregnancy outcomes to a randomly selected group of 24 women with HELLP syndrome treated at Mayo Gn ic between 1986 and 1994. Results: We did not observe a statistically significant difference in maternal demographics or diagnostic laboratory findings. Prior to 1982, fetal mortality was significantly higher. The incidence and severity of acute renal failure and other cumulative maternal complications (including pulmonary edema, pleural effusion, pericardial effuslon, intracerebral hemorrhage, seizure, hepatic necrosis, and retinal detachment) were significantly higher prior to 1982. After 1982, the time from diagnosis to delivery was significantly shorter (2.5 vs. 14 days), and patients weremore likely to receive seizure prophylaxis with magnesium sulfate. There was a trend towards more Caesarian sections and labor induction in women treated after 1982. Condusions: These observations suggest that recognition of HELLP as a distinct clinical syndrome has led to improved outcomes of pregnancies, probably due to more timely diagnosis and earlier termination of pregnancy.