| Background:HELLP Syndrome is one of the deadly obstetric complications habitually considered a variant of preeclampsia.It was Louis Martin Weinstein who first proposed the abbreviation in 1982.He branded it as a separate clinical manifestation?compared to severe preeclampsia?.There are minor differences in the reported incidence rates of HELLP in pregnant women in general and preeclamptic women in particular,according to some literature it occurs in 5-9 percent of all pregnancies and in 10-20 percent of all preeclamptic women.Although the pathophysiology and pathogenesis HELLP syndrome has been explained to some degree,it is not well understood yet and an exact cause remains to be found,it has a shared etiologic mechanism,which is injury of the endothelial cells,with other conditions,such as thrombotic thrombocytopenic purpura and acute renal failure.The earliest signs of HELLP syndrome start showing midway through the third trimester,nonetheless these signs cans show in earlier and later stages.Symptoms differ in their degree of severity and from one individual to another,and are commonly misidentified with the symptoms of normal pregnancy,particularly if they are not severe.In order to diagnose HELLP syndrome accurately and promptly laboratory assessments and imaging exams are needed.Nonetheless,diagnosis of HELLP is challenging,particularly due to the inconsistency in the signs and symptoms and the lack of agreement amongst healthcare experts.Resemblances to other disorders or also to normal pregnancy characteristics,often leads to the misdiagnosis or delay of the diagnosis of HELLP.The Mississippi classification method is the most commonly used method of classifying HELLP?Class I,II,and III?that measures the seriousness of the syndrome based on platelet counts in the patients plus the other two main clinical criteria?hemolysis and liver dysfunction?.The most severe one is Class I,which has a comparatively higher risk of morbidity and mortality,in comparison to the other two classes.A different classification method,introduced in Memphis Tennessee,classifies the syndrome based on its expression?partial and complete?.HELLP syndrome associated complications affect both the child and the mother.The maternal mortality rate is reported at 1.1 percent.Nonetheless greater maternal mortality rates of up to 25 percent have been observed.HELLP syndrome associated perinatal mortality rate is between 7.4–34 percent.34 percent of perinatal death occurred before women reached 32 weeks of pregnancy,and 8 percent of perinatal death after the 32 weeks of pregnancy.Therefore,the analysis of the clinical and laboratory features of HELLP syndrome and the exploration of its rules are of great potential social and economic value for improving the prognosis of mothers and infants.Objectives:1.The clinical and laboratory characteristics of pregnant women with HELLP syndrome as distinct from those with simple severe preeclampsia were compared and analyzed,so as to provide potential candidate indicators for the prediction of the occurrence of HELLP syndrome.2.The clinical and laboratory characteristics of early and late HELLP syndrome were compared and analyzed.3.To explore the analysis of the indicator ratio of termination of pregnancy with early onset HELLP syndrome.4.To evaluate the efficacy parameter analysis of dexamethasone in the treatment of HELLP syndrome.Methodology:A retrospective study cohort the clinical data of patients undergoing hypertensive disorders complicating pregnancy were admitted to the Department of Obstetrics of the First Affiliated Hospital of Jilin University from January 19th,2013,to January30th,2018.Our simple population comprised pregnant women who were diagnosed with HELLP syndrome and severe PE.Among 106 patients,38 patients with early onset HELLP syndrome,19 patients with late onset HELLP syndrome and 41 patients with severe PE were collected and analyzed respectively.Clinical features,maternal demographic,neonatal outcomes of the pregnant women were extracted from the maternal medical records and the data analyzed.Clinical data included Blood pressure,Creatinine,Albumin,LDH?lactate dehydrogenase?,Hemoglobin,Hematocrit,platelet number before and after dexamethasone,24hours urine protein,ALT/AST before and after dexamethasone treatment,Total bilirubin,serum uric acid and myocardial injury marker ckmb/troponin I/myoglobin.Maternal demographics included?gestational age in weeks,the onset of gestational age and Gestational age of delivery?.Neonatal outcomes data included?neonatal weight and APGAR scores?.All the maternal medical records were reviewed and the above data were extracted and analyzed.Primarily,we performed the analysis by comparing HELLP syndrome with severe PE,the relationship of gestational age in early and onset HELLP gestation was further analyzed relative to the 34 week mark,followed by understanding the factors of HELLP syndrome,accurately and promptly laboratory tests are needed to be calculated and analyzed depending on platelets count.They were well-defined ass the effective group who shows us better results.Finally,Comparison of before and after dexamethasone based on the platelets groups,?Platelet<50×109/L?,?50-100×109/L?,?>100×109/L?,AST and ALT successfully.Data were analyzed using the statistical software package IBM SPSS Statistics 24.0.Normal distributed variables were described as mean?M?±standard deviation?SD?,and the differences between groups were compared via t test and one-way ANOVA?analysis of variance?test,abnormal distribution variables were described as median?interquartile,IQR?.The differences between groups were compared via non-parametric tests?Mann-Whitney U test and Kruskal-Wallis H test?.P value<0.05 was considered as statistically significant.Results:1.Among the 108 patient data evaluated 38 cases were early onset HELLP syndrome,while 19 cases were late onset HELLP syndrome,and 41 were severe Preeclampsia cases.2.Clinical and laboratory characteristics of HELLP syndrome and severe PE were compared.The results showed that platelets in patients with severe PE were significantly higher than those in patients with HELLP syndrome?P<0.001?,and serum uric acid in patients with severe preeclampsia was significantly lower than that in patients with HELLP syndrome?P=0.007?.3.Compare and analyze whether there are differences in clinical and laboratory characteristic parameters of HELLP syndrome between early onset?gestational age<34 weeks?and late onset?gestational age?34 weeks?.The 24-hour urine protein ration of pregnant women with early-onset HELLP syndrome was significantly increased compared with those with late-onset HELLP syndrome?P=0.009?.Myoglobin,gestational age and neonatal weight in the myocardial injury criteria of pregnant women with late-onset HELLP syndrome were significantly higher than those with early-onset HELLP syndrome?P=0.004,P=0.040,P<0.001?.The other parameters showed no significant difference with early-onset HELLP syndrome.4.Pregnant women with HELLP syndrome were divided into three groups according to platelet count<50×109/L,50-100×109/L,and>100×109/L.There were no significant differences between the three groups in age,blood pressure,24-hour urine protein quantification,creatinine and other laboratory results.However,there were significant differences in platelet counts between the groups?P<0.001?.In addition,lactate dehydrogenase?P=0.008?and total bilirubin?P=0.004?in the group with platelet count<50×109/L were significantly higher than those in the group with platelet count 50-100×109/L and the group with platelet count>100×109/L.5.Among the 38 patients with early-onset HELLP syndrome,34?89.47%?underwent cesarean section and 4?10.63%?underwent vaginal delivery?figure4.1?.Of all the indicators of childbirth,27 were maternal organ failure or damage?70.05%?,4 were gestational?34 weeks?10.53%?,4 were fetal distress?10.53%?,and3 were fetal death?7.89%?.Maternal organ failure or injury is the main indication of childbirth.6.Pregnant women with HELLP syndrome were divided into three groups according to platelet count<50×109/L,50-100×109/L,and>100×109/L.In the data before and after dexamethasone treatment,the platelet count after dexamethasone treatment was significantly higher than that before dexamethasone treatment for patients with platelet levels below 50×109/L and between 50×100×109/L?P=0.001;P=0.010?.In patients with platelet level above 100×109/L,platelets after dexamethasone treatment were significantly lower than those before dexamethasone treatment?P=0.001?,which was considered to be postpartum HELLP syndrome.Conclusion:1.Serum uric acid level was found to be elevated in the HELLP syndrome group compared with the severe preeclampsia group,suggesting that serum uric acid level could be used as a potential predictor of HELLP syndrome.2.The 24-hour urine protein quantification was higher in the early-onset HELLP syndrome group compared with the late-onset HELLP syndrome group,suggesting that there was more serious renal injury in the early-onset HELLP syndrome group.Myoglobin was higher in the myocardial injury standard in the group with late-onset HELLP syndrome,suggesting that the late-onset lesions involved the heart more.Organ damage in the HELLP syndrome group was the earliest to involve the kidney,and with the progression and delay of the disease,it would involve the heart.3.HELLP syndrome was classified according to the platelet count range,and it was found that with the decrease of platelets,lactate dehydrogenase increased in pregnant women,and the total bilirubin level also increased,suggesting that lactate dehydrogenase and total bilirubin levels could be used as potential indicators to evaluate the severity of HELLP syndrome.4.In early-onset HELLP syndrome,maternal organ failure or injury is the primary indication of childbirth.5.The parameter of reduced platelet count in HELLP syndrome was significantly improved by dexamethasone therapy.6.Strengthening prenatal care and dynamic monitoring of 24-hour urine protein quantification,blood routine,liver function,kidney function,serum uric acid and lactate dehydrogenase levels in preeclampsia patients are of significance for the prevention and early detection of HELLP syndrome and the reduction of maternal and infant complications and mortality. |
PDF Full Text Request