HELLP syndrome in preterm pregnancies: pathophysiologic evidence for antepartum use of corticosteroids
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Carreño-Almánzar, F. R. (2015). HELLP syndrome in preterm pregnancies: pathophysiologic evidence for antepartum use of corticosteroids. Médicas UIS, 28(1), 53–63. Retrieved from https://revistas.uis.edu.co/index.php/revistamedicasuis/article/view/4905

Abstract

Introduction: the use of antepartum corticosteroids may attenuate the inflammatory process of HELLP syndrome in preterm pregnancies allowing improved maternal and neonatal outcomes. Objective: identifying maternal and neonatal benefits of using corticosteroids in antepartum preterm pregnancies complicated by HELLP through a review of the literature. Methodology: A review was conducted between July and September 2013, including clinical trials in English or Spanish about the usefulness of antepartum corticosteroids in preterm pregnancies complicated by HELLP syndrome and fetal-maternal repercussions of its use. Results: four clinical trials involving 248 pregnancies comparing the use of dexamethasone, betamethasone or prednisolone with placebo were reviewed, potential benefits as prolonging pregnancy, reducing exacerbations and reduced need for transfusions in this population was found. Conclusions: corticosteroid therapy may be useful in stabilizing antepartum patients between 48-72 hours to ensure the move to more complex centers, in reducing recurrence of HELLP syndrome, in expectant management in preterm pregnancies and reducing transfusion need; however, more studies are needed to assess this indications. MÉD.UIS. 2015;28(1):53-63.

Keywords: HELLP syndrome. Dexamethasone. Betamethasone. Adrenal cortex hormones. Obstetric labor, premature.

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References

Hladunewich M, Karumanchi SA, Lafayette R. Pathophysiology of the clinical manifestations of preeclampsia. Clin J Am Soc Nephrol. 2007;2(3):543-9.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206-52.

Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ. 2005;330(7491):565-7.

López-Carbajal MJ, Manríquez-Moreno ME, Gálvez-Camargo D, Ramírez-Jiménez E. Factores de riesgo asociados con preeclampsia. Rev Med Inst Mex Seguro Soc. 2012;50(5):471-6.

Reyes LM, García RG, Ruiz SL, Camacho PA, Ospina MB, Aroca G, et al. Risk factors for preeclampsia in women from Colombia: a case-control study. PLoS One. 2012;7(7):e41622.

Osungbade KO, Ige OK. Public health perspectives of preeclampsia in developing countries: implication for health system strengthening. J Pregnancy. 011;2011:481095.

Ganesan C, Maynard SE. Acute kidney injury in pregnancy: the thrombotic microangiopathies. J Nephrol. 2011;24(5):554-63.

Vigil-De Gracia P, Ortega-Paz L. Pre-eclampsia/eclampsia and hepatic rupture. Int J Gynaecol Obstet. 2012;118(3):186-9.

Habli M, Eftekhari N, Wiebracht E, Bombrys A, Khabbaz M, How H, et al. Long-term maternal and subsequent pregnancy outcomes 5 years after hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Am J Obstet Gynecol.

;201(4):385.e1-5.

Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: clinical issues and management. A Review. BMC Pregnancy Childbirth. 2009;9:8.

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.

Vigil-De Gracia P. Maternal deaths due to eclampsia and HELLP syndrome. Int J Gynaecol Obstet. 2009;104(2):90-4.

Ertan AK, Wagner S, Hendrik HJ, Tanriverdi HA, Schmidt W. Clinical and biophysical aspects of HELLP-syndrome. J Perinat Med. 2002;30(6):483-9.

Martin JN Jr, Rinehart BK, May WL, Magann EF, Terrone DA, Blake PG. The spectrum of severe preeclampsia: comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification. Am J Obstet Gynecol. 1999;180(6 Pt 1):1373-84.

Martin JN Jr, Rose CH, Briery CM. Understanding and managing HELLP syndrome: the integral role of aggressive glucocorticoids for mother and child. Am J Obstet Gynecol. 2006;195(4):914-34.

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.

Sibai BM, Barton JR. Expectant management of severe preeclampsia remote from term: patient selection, treatment, and delivery indications. Am J Obstet Gynecol.

;196(6):514.e1-9.

Barton JR, Sibai BM. Diagnosis and management of hemolysis, elevated liver enzymes, and low platelets syndrome. Clin Perinatol. 2004;31(4):807-33.

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.

Sibai BM, Akl S, Fairlie F, Moretti M. A protocol for managing severe preeclampsia in the second trimester. Am J Obstet Gynecol. 1990;163(3):733-8.

Churchill D, Duley L. Interventionist versus expe ctant care forsevere pre-eclampsia before term. Cochrane Database Syst Rev. 2002(3):CD003106.

Aloizos S, Seretis C, Liakos N, Aravosita P, Mystakelli C, Kanna E, et al. HELLP syndrome: understanding and management of a pregnancy-specific disease. J Obstet Gynaecol. 2013;33(4):331-7.

Churchill D, Duley L, Thornton JG, Jones L. Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks’ gestation. Cochrane Database Syst Rev. 2013;7:CD003106.

Wang YQ, Wang J, Ye RH, Zhao YY. Investigation of diagnosis and treatment of hemolysis-elevated liver enzymes-low platelet counts (HELLP) syndrome: clinical analysis of 59 cases. Chin Med J (Engl). 2010;123(10):1273-7.

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.

Magann EF, Martin RW, Isaacs JD, Blake PG, Morrison JC, Martin JN Jr. Corticosteroids for the enhancement of fetal lung maturity: impact on the gravida with preeclampsia and the HELLP syndrome. Aust N Z J Obstet Gynaecol. 1993;33(2):127-31.

Schlembach D, Munz W, Fischer T. Effect of corticosteroids on HELLP syndrome: a case report. J Perinat Med. 2000;28(6):502-5.

van Runnard Heimel PJ, Kavelaars A, Heijnen CJ, Peters WH, Huisjes AJ, Franx A, et al. HELLP syndrome is associated with an increased inflammatory response, which may be inhibited by administration of prednisolone. Hypertens Pregnancy.

;27(3):253-65.

van Runnard Heimel PJ, Franx A, Schobben AF, Huisjes AJ, Derks JB, Bruinse HW. Corticosteroids, pregnancy, and HELLP syndrome: a review. Obstet Gynecol Surv. 2005;60(1):57-70.

Wallace K, Martin JN Jr, Tam Tam K, Wallukat G, Dechend R, Lamarca B, et al. Seeking the mechanism(s) of action for corticosteroids in HELLP syndrome: SMASH study. Am J Obstet Gynecol. 2013;208(5):380.e1-8.

Aggarwal PK, Chandel N, Jain V, Jha V. The relationship between circulating endothelin-1, soluble fms-like tyrosine kinase-1 and soluble endoglin in preeclampsia. J Hum Hypertens. 2012;26(4):236-41.

3Whitehead CL, Palmer KR, Nilsson U, Gao Y, Saglam B, Lappas M, et al. Placental expression of a novel primate-specific splice variant of sFlt-1 is upregulated in pregnancies complicated by severe early onset pre-eclampsia. BJOG. 2011;118(10):1268-71.

Sibai BM, Barton JR. Dexamethasone to improve maternal outcome in women with hemolysis, elevated liver enzymes, and low platelets syndrome. Am J Obstet Gynecol. 2005;193(5):1587-90.

van Runnard Heimel PJ, Schobben AF, Huisjes AJ, Franx A,Bruinse HW. The transplacental passage of prednisolone in pregnancies complicated by early-onset HELLP syndrome. Placenta. 2005;26(10):842-5.

Katz L, Amorim MM, Miranda GV, Pinto e Silva JL. Clinical and laboratorial profile and complications of patients with HELLP syndrome admitted in an obstetric intensive care unit. Rev Bras Ginecol Obstet. 2008;30(2):80-6.

Mould S, Paruk F, Moodley J. High-dose dexamethasone in the treatment of HELLP syndrome. Int J Gynaecol Obstet.2006;93(2):140-1.

Isler CM, Barrilleaux PS, Magann EF, Bass JD, Martin JN, Jr. A prospective, andomized trial comparing the efficacy of dexamethasone and betamethasone for the treatment of antepartum HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Am J Obstet Gynecol. 2001;184(7):1332-7; discussion 7-9.

O’Brien JM, Milligan DA, Barton JR. Impact of high-dose corticosteroid therapy for patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Am J Obstet Gynecol. 2000;183(4):921-4.

Vigil-De Gracia P. Garcia-Cáceres E. Dexamethasone in the postpartum treatment of HELLP syndrome. Int J Gynaecol Obstet.

;59(3):217-21.

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.

;171(4):1148-53.

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.

Ozer A, Kanat-Pektas M, Ozer S, Tapisiz OL, Zulfikaroglu EE, Danisman N. The effects of betamethasone treatment on clinical and laboratory features of pregnant women with HELLP syndrome. Arch Gynecol Obstet. 2009;280(1):65-70.

van Runnard Heimel PJ, Huisjes AJ, Franx A, Koopman C, Bots ML, Bruinse HW. A randomised placebo-controlled trial of prolonged prednisolone administration to patients with HELLP syndrome remote from term. Eur J Obstet Gynecol Reprod Biol.

;128(1-2):187-93.

Vigil-De Gracia P. Dexamethasone treatment and HELLP syndrome. Am J Obstet Gynecol. 2006;195(6):e10; author reply e1-2.

Sibai BM, Taslimi MM, el-Nazer A, Amon E, Mabie BC, Ryan GM. Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia-eclampsia. Am J Obstet Gynecol. 1986;155(3):501-9.

Isler CM, Rinehart BK, Terrone DA, Martin RW, Magann EF, Martin JN, Jr. Maternal mortality associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Am J Obstet Gynecol. 1999;181(4):924-8.

Altman D, Carroli G, Duley L, Farrell B, Moodley J, Neilson J, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebocontrolled trial. Lancet. 2002;359(9321):1877-90.

Gul A, Cebeci A, Aslan H, Polat I, Ozdemir A, Ceylan Y. Perinatal outcomes in severe preeclampsia-eclampsia with and without HELLP syndrome. Gynecol Obstet Invest. 2005;59(2):113-8.

Celik C, Gezginç K, Altintepe L, Tonbul HZ, Yaman ST, Akyürek C, et al. Results of the pregnancies with HELLP syndrome. Ren Fail. 2003;25(4):613-8.

Zuberi NF, Arif K, Khan FM, Pal JA. A comparison of severe pre-eclampsia/eclampsia in patients with and without HELLP syndrome. J Pak Med Assoc. 1998;48(2):29-32.

Abramovici D, Friedman SA, Mercer BM, Audibert F, Kao L, Sibai BM. Neonatal outcome in severe preeclampsia at 24 to 36 weeks’ gestation: does the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome matter? Am J Obstet Gynecol. 1999;180(1 Pt 1):221-5.

van Pampus MG, Wolf H, Westenberg SM, van der Post JA, Bonsel GJ, Treffers PE. Maternal and perinatal outcome after expectant management of the HELLP syndrome compared with pre-eclampsia without HELLP syndrome. Eur J Obstet Gynecol Reprod Biol. 1998;76(1):31-6.

Matchaba P, Moodley J. Corticosteroids for HELLP syndrome in pregnancy. Cochrane Database Syst Rev. 2004;(1):CD002076.

Woudstra DM, Chandra S, Hofmeyr GJ, Dowswell T. Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy. Cochrane Database Syst Rev. 2010;(9):CD008148.

Katz L, Amorim M, Souza JP, Haddad SM, Cecatti JG. COHELLP: collaborative randomized controlled trial on corticosteroids in HELLP syndrome. Reprod Health. 2013;10:28.

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