Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Weinstein L: Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy.
1982. Am J Obstet Gynecol 2005, 193:859.
Sibai BM: Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet
Gynecol 2004, 103:981-991.
EPIDEMIOLOGÍA
El síndrome HELLP se
presenta en alrededor de
0,1 a 0,8% de todos los
embarazos.
Se presenta en 10 a 20%
de los casos con
preeclampsia
severa/eclampsia.
EPIDEMIOLOGÍA
30% de los Sd. Hellp se
presentan en el posparto.
20% despues de la ss 37
70% entre ss 27 y 37
LA TRÍADA DEL SÍNDROME HELLP:
La presencia de fragmentos de
globulos rojos (esquistocitos) o
globulos rojos con espiculas
(células Burr) en el frotis de
sangre periférica
refleja el proceso hemolítico y
sugiere fuertemente el
desarrollo de MAHA.
Weinstein L: Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. 1982. Am J Obstet
Gynecol 2005, 193:859.
Sibai BM: Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol 2004,
103:981-991.
LA TRÍADA DEL SÍNDROME HELLP:
HEMÓLISIS
Rath W, Faridi A, Dudenhausen JW: HELLP syndrome. J Perinat Med 2000, 28:249-260.
LA TRÍADA DEL SÍNDROME HELLP:
HEMÓLISIS
Poldre PA: Haptoglobin helps diagnose the HELLP syndrome. Am J Obstet Gynecol 1987, 157:1267.
LA TRÍADA DEL SÍNDROME HELLP:
ELEVACIÓN DE ENZIMAS HEPÁTICAS
Knapen MF, Mulder TP, Bisseling JG, Penders RH, Peters WH, Steegers EA: Plasma glutathione S-transferase alpha 1-1: a more sensitive marker for
hepatocellular damage than serum alanine aminotransferase in hypertensive disorders of pregnancy. Am J Obstet Gynecol 1998, 178:161-165.
LA TRÍADA DEL SÍNDROME HELLP:
ELEVACIÓN DE ENZIMAS HEPÁTICAS
Knapen MF, Mulder TP, Bisseling JG, Penders RH, Peters WH, Steegers EA: Plasma glutathione S-transferase alpha 1-1: a more sensitive marker for
hepatocellular damage than serum alanine aminotransferase in hypertensive disorders of pregnancy. Am J Obstet Gynecol 1998, 178:161-165.
LA TRÍADA DEL SÍNDROME HELLP:
TROMBOCITOPENIA
Preeclampsia (10%),
Parnas M, Sheiner E, Shoham-Vardi I, Burstein E, Yermiahu T, Levi I, Holcberg G, Yerushalmi R: Moderate to severe thrombocytopenia during pregnancy.
Eur J Obstet Gynecol Reprod Biol 2006, 128:163-168.
Baxter JK, Weinstein L: HELLP syndrome: the state of the art. Obstet Gynecol Surv 2004, 59:838-845.
LA TRÍADA DEL SÍNDROME HELLP:
TROMBOCITOPENIA
Parnas M, Sheiner E, Shoham-Vardi I, Burstein E, Yermiahu T, Levi I, Holcberg G, Yerushalmi R: Moderate to severe thrombocytopenia during pregnancy.
Eur J Obstet Gynecol Reprod Biol 2006, 128:163-168.
Baxter JK, Weinstein L: HELLP syndrome: the state of the art. Obstet Gynecol Surv 2004, 59:838-845.
LA TRÍADA DEL SÍNDROME HELLP:
TROMBOCITOPENIA
ACTIVACION DE AT III
DEGRADACION DE PRODUCTOS DE FIBRINA
Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA: Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver
enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol 1993, 169:1000-1006.
CRITERIOS DIAGNÓSTICOS
Aloizos S1 et al. HELLP syndrome: understanding and management of a pregnancy-specific disease. J Obstet Gynaecol. 2013;33(4):331-7.
INDICADORES DE
SEVERIDAD
LDH > 1400 U/L
Kjell Haram,Einar Svendsen, Ulrich Abildgaard ; The HELLP syndrome: Clinical issues and management. A Review; BMC Pregnancy and Childbirth 2009,
9:8
DIAGNOSTICO DIFERENCIAL
HEPATITIS AGUDA
COLECISTITIS
PANCREATITIS
LUPUS
HIGADO GRASO DEL EMBARAZO
PURPURA TROMBOCITOPENICA
SD. UREMICO HEMOLITICO
SHOCK HEMORRAGICO O SEPTICO
Aloizos S1 et al. HELLP syndrome: understanding and management of a pregnancy-specific disease. J Obstet Gynaecol. 2013;33(4):331-7.
COMPLICACIONES
HEMORRAGIA
OLIGURIA (47%)
RCIU 38-61
SDR 5.7-40
Haddad B, Barton JR, Livingston JC, Chahine R, Sibai BM: Risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver
enzymes, and low platelet count) syndrome. Am J Obstet Gynecol 2000, 183:444-448.
MANEJO DEL SD. HELLP
OBJETIVOS:
PREVENCION DE COMPLICACIONES
HEMORRAGICAS
PREVENCION DE COMPLICACIONES DE
ECLAMPSIA
CONTROL DE HIPERTENSION
INICIO DE TRABAJO DE PARTO
INDUCCION DEL TRABAJO
> 34 SS
DE PARTO
MADURACION PULMONAR EN
< 34 SS AUSENCIA DE COMPLICACIONES
SERIAS:
• HEMATOMA HEPATICO
• TROMBOCITOPENIA SEVERA
• ECLAMPSIA
PASOS DE O´BRIEN et al:
1. SOSPECHA DIAGNOSTICA EN MUJERES CON PE
2. LABORATORIO Y DX. DIFERENCIAL
3. EVALUACION DE CONDICION FETAL Y MATERNA
4. CONTROL DE PA
5. VIA PERIFERICA, MgSO4, DROGAS ANTIHTA
6. CONSIDERAR MADURACION PULMONAR
7. VALORAR HEMOTERAPIA
8. VALORAR USO DE ECOGRAFIA HEPATICA
9. EN CASO DE CESAREA, EVALUACION CON ANESTESIOLOGO EL
PROCEDIMIENTO.
10. MANEJO ACTIVO DEL TRABAJO DE PARTO
11. PLAN DE MANEJO EN UCI DE LA MADRE O EL RN
12. LABORATORIO CADA 6-24 HORAS DE ACUERDO A LA SEVERIDAD HASTA LA
ESTABILIZACION.
13. MANTENIMIENTO DEL USO DE ANTIHIPERTENSIVOS O MgSO4 EN EL
PUERPERIO.
14. CONSEJERIA SOBRE GESTACIONES FUTURAS
CORTICOESTEROIDES
MECANISMO DE ACCION:
REDUCCION DE LA ADHESION PLAQUETARIA
REDUCCION DE LA REMOCION
PLAQUETARIA POR EL BAZO.
AUMENTA LA ACTIVACION PLAQUETARIA
Kjell Haram,Einar Svendsen, Ulrich Abildgaard ; The HELLP syndrome: Clinical issues and management. A Review; BMC Pregnancy and Childbirth 2009, 9:8
DOSIS:
DEXAMETASONA 10 mg EV cada12 HORAS
Woudstra D et al. Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy. Cochrane Database of Systematic
Reviews 2010, Issue 9. Art. No.: CD008148.
MEDICAMENTOS ANTIHIPERTENSIVOS
Magee LA, Helewa M, Moutquin JM, von Dadelszen P, Hypertension Guideline Committee, Society of Obstetricians and Gynaecologists of Canada. Diagnosis
and classification. In: Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. J Obstet Gynaecol Can 2008 Mar;30(3 Suppl 1):S9-
15
MEDICAMENTOS ANTIHIPERTENSIVOS
Magee LA, Helewa M, Moutquin JM, von Dadelszen P, Hypertension Guideline Committee, Society of Obstetricians and Gynaecologists of Canada. Diagnosis
and classification. In: Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. J Obstet Gynaecol Can 2008 Mar;30(3 Suppl 1):S9-
15
MEDICAMENTOS ANTIHIPERTENSIVOS
Magee LA, Helewa M, Moutquin JM, von Dadelszen P, Hypertension Guideline Committee, Society of Obstetricians and Gynaecologists of Canada. Diagnosis
and classification. In: Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. J Obstet Gynaecol Can 2008 Mar;30(3 Suppl 1):S9-
15
MANEJO DE LA TROMBOCITOPENIA
TRANSFUSION DE PLAQUETAS:
Magee LA, Helewa M, Moutquin JM, von Dadelszen P, Hypertension Guideline Committee, Society of Obstetricians and Gynaecologists of Canada. Diagnosis
and classification. In: Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. J Obstet Gynaecol Can 2008 Mar;30(3 Suppl 1):S9-
15
La anestesia regional está indicada para los casos con
recuentos de ≥ 75,000 - 100,000/ul
Score BISHOP
Edad gestacional
La condición de la madre
Sibai BM: Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet
Gynecol 2004, 103:981-991.
Baxter JK, Weinstein L: HELLP syndrome: the state of the art. Obstet Gynecol Surv 2004, 59:838-845.
INTERRUPCIÓN DEL
EMBARAZO
Esta indicada la cesárea:
Bishop menor de 5
Sibai BM: Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol 2004,
103:981-991.
Baxter JK, Weinstein L: HELLP syndrome: the state of the art. Obstet Gynecol Surv 2004, 59:838-845.
GRACI
AS