Şiddetli Preeklampsiye Eşlik Eden HELLP Sendromu Olgularında Maternal ve Perinatal Sonuçların Değerlendirilmesi
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Tarih
2019
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: HELLP (hemoliz, yükselmiş karaciğer enzimleri, düşük trombosit sayısı) sendromunun eşlik ettiği şiddetli preeklamsi olguları ile HELLP sendromu olmayan şiddetli preeklampsi olgularında maternal ve perinatal sonuçların değerlendirilmesidir. Gereç ve Yöntem: Hastanemizde 2015 Ocak ile 2018 Temmuz arasında tanı almış ve doğum yapmış şiddetli preeklampsili gebeler retrospektif olarak değerlendirildi. Hastalar HELLP sendromu parametrelerine göre HELLP sendromu bulunan (Grup 1) ve bulunmayan (Grup 2) olarak iki gruba ayrıldı. İki grup preterm doğum, IUGR, dekolman plasenta, fetal ölüm gibi perinatal komplikasyonlar, bazı maternal morbidite ve mortalite nedenleri ve hematolojik ve biyokimyasal parametreler açısından değerlendirildi. Bulgular: 2015 Ocak ile 2018 Temmuz arasında hastanemizde 8730 doğum gerçekleşti ve 154 (%1.7) gebeye şiddetli preeklampsi (Grup 1), 38 (%0.4) gebe ise şiddetli preeklampsi+HELLP (Grup 2) sendromu tanısı aldı. Grup 1’de intrauterin gelişme geriliği 22 (%14.2), dekolman plasenta 8 (%5.2), preterm doğum %32.4 oranında görülürken, Grup 2’de bu oranlar sırasıyla 7 (%18.4), 3 (%7.8) ve % 26.3 olarak bulundu ve gruplar arasında anlamlı fark bulunmadı. Fetal ölüm oranları (%1.2’ye %5.2) ve sezaryen doğum oranları (%77.2’ye %86.8) açısından da gruplar açısından anlamlı fark bulunmadı ancak oranlar Grup 2’de daha yüksekti. Akut böbrek yetmezliği, dissemine intravasküler koagülasyon, yoğun bakım ihtiyacı ile kan ve kan ürünü transfüzyonu ihtiyacı da Grup 2’de daha yüksekti ve istatistiksel anlamlı fark tespit edildi. Sonuç: Şiddetli preeklampsi ve özellikle şiddetli preeklampsiye eşlik eden HELLP sendromu varlığı perinatal komplikasyonların yanında ciddi maternal morbidite ve mortalite artışı ile birliktelik göstermekte olup mümkün olan en kısa zamanda gebeliğin sonlandırılması ve uygun destek tedavisinin verilmesi gerekmektedir.
Objective: Our objective is to evaluate maternal and perinatal outcomes in severe preeclampsia cases with HELLP syndrome (hemolysis, raised liver function tests, low platelet count) and severe preeclampsia cases without HELLP syndrome. Methods: Pregnant women with severe preeclampsia who had been diagnosed and delivered at our hospital between January 1015 and July 2018 were evaluated retrospectively. Patients were divided into two groups as those with HELLP syndrome (Group 1) and as those without HELLP syndrome (Group 2) according to the aformentioned HELLP syndrome parameters. Both groups were assessed in terms of some perinatal complications such as preterm delivery, IUGR, abruptio placenta and fetal and some biochemical and hematologic parameters. Results: Between January 2015 and July 2018, a total of 8730 deliveries were made in our hospital. 154 (1.7%) women had got a diagnosis of severe preeclampsia without HELLP syndrome (Group 1). 38 (0.4%) had severe preeclampsia with HELLP (Group 2). In Group 1, 22 cases had IUGR (14.2%), 8 had abruptio placenta (5.2%), 50 had preterm delivery (32.4%). In Group 2, 7 cases had IUGR (18.4%), 3 had abruptio placenta (7.8%) and 10 (26.3%) had preterm delivery. There was no statistically significant difference between groups in terms of all three parameters. Although there were no significant differences, fetal mortality (1.2% vs 5.2%) and cesarean rates (77.2% vs 86.8%) were higher in Group 2. We detected significance in terms of acute renal failure and disseminated intravascular coagulopathy rates, need for invasive care and blood product transfusion between groups. All were higher in latter. Conclusion: Severe preeclampsia, particularly ones with HELLP, are related to high perinatal complications and increased maternal mortality and morbidity, it is necessary to terminate such pregnancies and to provide appropriate supportive therapy in time.
Objective: Our objective is to evaluate maternal and perinatal outcomes in severe preeclampsia cases with HELLP syndrome (hemolysis, raised liver function tests, low platelet count) and severe preeclampsia cases without HELLP syndrome. Methods: Pregnant women with severe preeclampsia who had been diagnosed and delivered at our hospital between January 1015 and July 2018 were evaluated retrospectively. Patients were divided into two groups as those with HELLP syndrome (Group 1) and as those without HELLP syndrome (Group 2) according to the aformentioned HELLP syndrome parameters. Both groups were assessed in terms of some perinatal complications such as preterm delivery, IUGR, abruptio placenta and fetal and some biochemical and hematologic parameters. Results: Between January 2015 and July 2018, a total of 8730 deliveries were made in our hospital. 154 (1.7%) women had got a diagnosis of severe preeclampsia without HELLP syndrome (Group 1). 38 (0.4%) had severe preeclampsia with HELLP (Group 2). In Group 1, 22 cases had IUGR (14.2%), 8 had abruptio placenta (5.2%), 50 had preterm delivery (32.4%). In Group 2, 7 cases had IUGR (18.4%), 3 had abruptio placenta (7.8%) and 10 (26.3%) had preterm delivery. There was no statistically significant difference between groups in terms of all three parameters. Although there were no significant differences, fetal mortality (1.2% vs 5.2%) and cesarean rates (77.2% vs 86.8%) were higher in Group 2. We detected significance in terms of acute renal failure and disseminated intravascular coagulopathy rates, need for invasive care and blood product transfusion between groups. All were higher in latter. Conclusion: Severe preeclampsia, particularly ones with HELLP, are related to high perinatal complications and increased maternal mortality and morbidity, it is necessary to terminate such pregnancies and to provide appropriate supportive therapy in time.
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