Gökhan YAVAŞ, H. Mete TANIR, İbrahim Anıl KULAKSIZ, Melih VELİPAŞAOĞLU

HELLP Sendromunda Postpartum Deksametazon Kullanımı

Amaç: Önemli bir perinatal ve maternal morbidite ve mortalite sebebi olan HELLP sendromunda gebeliğin sonlandırılması dışında şu an için kanıtlanmış etkin bir tedavi metodu bulunmamaktadır.Çalışmanın amacı HELLP sendromu olgularında doğum sonrası uygulanan deksametazon protokolünün maternal mortalite, laboratuvar belirteçlerinin normale dönme süresi ve hastanede kalış süresine etkisini incelemektir.Gereç ve Yöntemler: Bu retrospektif çalışmaya Ekim 2001 ve Mayıs 2015 tarihleri arasında doğum yapan HELLP sendromu olguları dahil edilmiştir. Hastalar postpartum dönemde deksametazon uygulanma durumuna göre iki gruba ayrılmıştır. Grup 1’deki olgulara postpartum dönemde 4 gün boyunca 12 saat arayla intravenöz 10 mg deksametazon uygulanmışken grup 2’deki hastalara bu uygulama yapılmamıştı. Çalışmanın birincil sonucu hastanede kalış süresi, ikincil sonuçları ise laboratuvar bulgularının normale dönme süresi ve maternal mortaliteydi.Bulgular: Çalışmaya dahil edilen toplam 52 hastanın 25’ine %48,1 deksametazon uygulanmış, 27’sine %51,9 ise uygulanmamıştı. İki grup arasında hastanede kalış süreleri, trombosit sayısı ve karaciğer fonksiyon testlerinin normale dönem süreleri arasında istatistiksel olarak anlamlı herhangi bir fark tespit edilmemiştir. Çalışmada maternal mortalite gerçekleşmemiştir.Sonuç: HELLP sendromunda postpartum dönemde deksametazon kullanımı ile ilgili çeşitli çalışmalarda çelişkili sonuçlar bulunmaktadır. Bizim çalışmamızda da, deksametazonun hastanede kalış süresi ve laboratuvar bulgularının normalleşme süresine etkisi olmadığı gösterilmiştir

Anahtar Kelimeler:

HELLP sendromu, Deksametazon, Maternal mortalite

Postpartum Dexamethasone Use in HELLP Syndrome

Objective: HELLP syndrome is an important cause of perinatal – maternal morbidity and mortality. There is currently no proven effective treatment method except the termination of pregnancy. The purpose of this study is to investigate the effects of postnatal dexamethasone protocol on maternal mortality, the duration of normalization of laboratory markers and hospital stay.Material and Methods: HELLP syndrome cases that delivered between October 2001 and May 2015 were included this retrospective study. The patients were divided into two groups according to the application of dexamethasone in the postpartum period. In Group 1, 10 mg of dexamethasone was administered intravenously every 12 hours in the postpartum period for 4 days, whereas this was not performed in Group 2. The primary outcome of the study was the length of stay in the hospital, the secondary outcomes were the normalization time of the laboratory findings and maternal mortality.Results: Of the 52 patients included in the study, 25 48.1% received dexamethasone and 27 51.9% did not. There was no statistically significant difference between the two groups in terms of hospital stay, platelet count, and duration of normalization of liver function tests. There was no maternal mortality in the study.Conclusion: There are conflicting results in various studies on the use of dexamethasone in the postpartum period in HELLP syndrome. In our study, dexamethasone has been shown to have no effect on the length of hospitalization and laboratory marker normalization

Keywords:

HELLP syndrome, Dexamethasone, Maternal mortality,

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Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: Clinical issues and management. A review. BMC Pregnancy Childbirth 2009; 9: 8.
Barton JR, Sibai BM. Gastrointestinal complications of pre-eclampsia. Semin Perinatol 2009; 33(3): 179-88.
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(4): 1000-6.
Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol 2004; 103(5 Pt 1): 981- 91.
Visser W, Wallenburg HC. Temporising management of severe pre-eclampsia with and without the HELLP syndrome. Br J Obstet Gynaecol 1995; 102(2): 111-7.
Fonseca JE, Mendez F, Catano C, Arias F. Dexamethasone treatment does not improve the outcome of women with HELLP syndrome: A double-blind, placebo-controlled, randomized clinical trial. Am J Obstet Gynecol 2005; 193(5): 1591-8.
Sibai BM. The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): Much ado about nothing? Am J Obstet Gynecol 1990; 162(2): 311-6.
Katz L, de Amorim MM, Figueiroa JN, Pinto e Silva JL. Postpartum dexamethasone for women with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome: A double-blind, placebo-controlled, randomized clinical trial. Am J Obstet Gynecol 2008; 198(3): 283 e1-8.
O’Brien JM, Shumate SA, Satchwell SL, Milligan DA, Barton JR. Maternal benefit of corticosteroid therapy in patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome: Impact on the rate of regional anesthesia. Am J Obstet Gynecol 2002; 186(3): 475-9.
Magann EF, Bass D, Chauhan SP, Sullivan DL, Martin RW, Martin JN Jr. Antepartum corticosteroids: Disease stabilization in patients with the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). Am J Obstet Gynecol 1994; 171(4): 1148-53.
Thiagarajah S, Bourgeois FJ, Harbert GM Jr, Caudle MR. Thrombocytopenia in preeclampsia: Associated abnormalities and management principles. Am J Obstet Gynecol 1984; 150(1): 1-7.
Snyder SR, Kivlehan SM, Collopy KT. HELLP Syndrome. How to recognize and treat this life-threatening complication of pregnancy. EMS World 2015; 44(6): 39- 45.
Wallace K, Martin JN Jr, Tam Tam K, Wallukat G, Dechend R, Lamarca B, Owens MY. Seeking the mechanism(s) of action for corticosteroids in HELLP syndrome: SMASH study. Am J Obstet Gynecol 2013; 208(5): 380 e1-8.
Martin JN Jr, Owens MY, Keiser SD, Parrish MR, Tam Tam KB, Brewer JM, Cushman JL, May WL. Standardized Mississippi Protocol treatment of 190 patients with HELLP syndrome: Slowing disease progression and preventing new major maternal morbidity. Hypertens Pregnancy 2012; 31(1): 79-90.
van Runnard Heimel PJ, Kavelaars A, Heijnen CJ, Peters WH, Huisjes AJ, Franx A, Bruinse HW. HELLP syndrome is associated with an increased inflammatory response, which may be inhibited by administration of prednisolone. Hypertens Pregnancy 2008; 27(3): 253-65.
Martin JN Jr, Thigpen BD, Rose CH, Cushman J, Moore A, May WL. Maternal benefit of high-dose intravenous corticosteroid therapy for HELLP syndrome. Am J Obstet Gynecol 2003; 189(3): 830-4.
Mao M, Chen C. Corticosteroid therapy for management of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome: A meta-analysis. Med Sci Monit 2015; 21: 3777-83.
Isler CM, Magann EF, Rinehart BK, Terrone DA, Bass JD, Martin JN Jr. Dexamethasone compared with betamethasone for glucocorticoid treatment of postpartum HELLP syndrome. Int J Gynaecol Obstet 2003; 80(3): 291-7.
Yalcin OT, Sener T, Hassa H, Ozalp S, Okur A. Effects of postpartum corticosteroids in patients with HELLP syndrome. Int J Gynaecol Obstet 1998; 61(2): 141-8.
Katz L, Amorim M, Souza JP, Haddad SM, Cecatti JG, C.S. Group. COHELLP: Collaborative randomized controlled trial on corticosteroids in HELLP syndrome. Reprod Health 2013; 10: 28.