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ACTUALIZACION SOBRE EL SINDROME HELLP

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Se describen las características del síndrome HELLP y se analizan las complicaciones maternas, su tratamiento y el pronóstico perinatal comparando diversas poblaciones.
malvino9.jpg Autor:
Eduardo roberto Malvino
Columnista Experto de SIIC

Institución:
Clínica y Maternidad Suizo Argentina

Artículos publicados por Eduardo roberto Malvino
Recepción del artículo
29 de Agosto, 2006 		Aprobación
28 de Septiembre, 2006
Primera edición
10 de Noviembre, 2006 		Segunda edición, ampliada y corregida
7 de Junio, 2021

ACTUALIZACION SOBRE EL SINDROME HELLP

Resumen
El síndrome de HELLP (hemólisis, enzimas hepáticas elevadas y plaquetopenia) se caracteriza por la presencia de los siguientes criterios: hemólisis (extendido de sangre periférica característico y láctico deshidrogenesa > 600 U/l o bilirrubina total > 1.2 mg/dl), aspartato aminotransferasa > 70 U/l, y recuento de plaquetas < 150 000/mm3. El síndrome HELLP es una variante de la preeclampsia y debido a su variada sintomatología el diagnóstico inicial puede pasar inadvertido. La mortalidad materna llega al 24%. Las pacientes con síndrome HELLP tienen elevado riesgo de padecer síndrome de distrés respiratorio del adulto, desprendimiento placentario, coagulación intravascular diseminada, ruptura de hematomas hepáticos e insuficiencia renal aguda. La mortalidad perinatal es igualmente alta, hasta del 37%. Antes del nacimiento, se requiere una conducta obstétrica agresiva para lograr la estabilización de los órganos afectados, seguida de la interrupción del embarazo en fase temprana para evitar la progresión acelerada de la enfermedad, una vez lograda la madurez pulmonar del feto. Las mujeres reciben sulfato de magnesio, dexametasona 8 mg intravenosa en dos dosis cada 12 horas antes de las 34a semana de gestación. Además, los corticoesteroides se utilizan cuando el recuento de plaquetas persiste por debajo de 30 000/mm3. El tratamiento definitivo es la interrupción del embarazo. Por lo tanto, el objetivo en el síndrome HELLP es el parto o la cesárea dentro de las 24 a 48 horas de diagnosticado, en un intento por reducir la incidencia de complicaciones. Las gestantes con el síndrome deben ser identificadas puntualmente e ingresadas en un centro de cuidados especializados para la atención de recién nacidos de alto riesgo.

Palabras clave
síndrome HELLP, preeclampsia, eclampsia, trombocitopenia, complicaciones del embarazo, mortalidad materna, evolución perinatal


Artículo completo
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HELLP SYNDROME

Abstract
HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelet count) is defined by the presence of the following criteria: hemolysis (characteristic peripheral blood smear and serum lactate dehydrogenase levels > 600 U/l or total bilirubin > 1.2 mg/dl), serum aspartate aminotransferase > 70 U/l, and platelet counts < 150 000/mm3. HELLP syndrome is a type of preeclampsia and because of its varied symptomatology; the initial diagnosis may be obscure. Maternal mortality has been estimated to be as high as 24%. Patients with HELLP syndrome have also an important risk of adult respiratory distress syndrome, abruptio placentae, disseminated intravascular coagulation, ruptured liver hematomas and acute renal failure. Perinatal mortality is equally high up to 37%. Before delivery, aggressive obstetric management is directed towards stabilization of the affected organ systems, if possible, timely interruption of its early phase, when the fetal lung maturity is obtained, so as to prevent accelerated disease progression. Women received dexamethason 8 mg in two doses every 12 hours before the 34th weeks of gestation. Corticosteroids were used when platelet count persisted under 30 000/mm3. Definitive therapy is delivery. Consequently the management in HELLP syndrome is prompt delivery in 24-48 hours in an attempt to reduce the incidence of complications. Patient with HELLP syndrome should be identified promptly and send to a tertiary care center for management of the newborn infants at risk.

Key words
HELLP syndrome, preeclampsia, eclampsia, thrombocytopenia, obstetrical critical care, maternal mortality, perinatal outcome

Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Obstetricia y Ginecología
Relacionadas: Cuidados Intensivos, Farmacología, Medicina Familiar, Medicina Farmacéutica, Medicina Interna, Pediatría



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