HELLP syndrome: preconditions for development, clinical forms, and diagnostic criteria


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Abstract

HELLP syndrome is associated with maternal mortality of 24.2-75% and perinatal mortality of 79%o and is commonly regarded a severe complication of preeclampsia. Objective: To identify the preconditions for the development and basic laboratory criteria for different forms of HELLP syndrome to improve diagnosis and maternal and perinatal outcomes. Materials and methods: This study retrospectively reviewed antenatal care cards and delivery notes of 22 patients with complete (n=7) and partial (n=15) HELLP syndrome. The analysis included age, medical history, specific characteristics of the course and outcome of pregnancy, and the main clinical and laboratory parameters. Quantitative variables were compared using the Mann-Whitney test; the arithmetic mean (M), standard deviation (SD), and the median difference were calculated. Binary variables are presented as counts and percentages with the effect expressed as odds ratio with 95% CI. Results: The age of14/22 (63.6%)patients rangedfrom 18 to 35years, and 17/22(77.3%) were multipara. HELLP syndrome developed during pregnancy and postpartum in 20/22 (90.9%) and 2/22 (9.1%) patients, respectively. Patients with the complete form of HELLP syndrome had more severe thrombocytopenia, proteinuria, and elevated levels of LDH, AST, ALT, and bilirubin. Patients with a partial form of the HELLP syndrome had more severe hypoproteinemia and higher BP. Only 1/22 (4.5%) patients with the complete form of HELLP syndrome complained of nausea and epigastric pain. Conclusion: Preeclampsia should not be considered as a background for the development of the complete form of HELLP syndrome, because both the Zangemeister triad and the combination of arterial hypertension and proteinuria were detected only in 9/15 (60%) patients with the partial form. Complete form was characterized by a sudden decrease in platelet count with a lightning-fast increase in LDH and bilirubin against a background of patient well-being.

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About the authors

Alexander N. Strizhakov

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: strizhakov_a_n@staff.sechenov.ru
Dr. Med. Sci., Academician of the RAS, Professor, Head of the Department of Obstetrics, Gynecology and Perinatology of the NV. Sklifosovsky Institute of Clinical Medicine

Irina M. Bogomazova

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: bogomazova_i_m@staff.sechenov.ru
PhD, Associate Professor at the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine

Irina A. Fedyunina

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: fedyunina_i_a@staff.sechenov.ru
PhD, Associate Professor at the Department of Obstetrics, Gynecology and Perinatology of the NV. Sklifosovsky Institute of Clinical Medicine

Irina V. Ignatko

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Dr. Med. Sci., Corresponding Member of the RAS, Professor of the RAS, Professor, Professor at the Department of Obstetrics, Gynecology and Perinatology of the NV. Sklifosovsky Institute of Clinical Medicine

Elena V. Timokhina

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Dr. Med. Sci., Associate Professor, Professor at the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine

Vera S. Belousova

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: belousova_v_s@staff.sechenov.ru
Dr. Med. Sci., Associate Professor, Professor at the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine

Vladimir A. Lebedev

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: lebedev_v_a@staff.sechenov.ru
Dr. Med. Sci., Professor, Professor at the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine

Nikolay M. Samashov

S.S. Yudin City Clinical Hospital, Moscow City Health Department

Email: bogomazova_i_m@staff.sechenov.ru
Obstetrician-Gynecologist at the maternity ward of the Maternity Hospital

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