Evaluación de la morbimortalidad materna en el síndrome HELLP en una maternidad de referencia de Piauí
DOI:
https://doi.org/10.33448/rsd-v11i7.29791Palabras clave:
Morbimortalidad; Síndrome HELLP; UCI.Resumen
Introducción: El síndrome HELLP en el embarazo se caracteriza por hemólisis, alteración de las enzimas hepáticas y trombocitopenia. Objetivo: Analizar la morbimortalidad materna por Síndrome HELLP en un hospital de referencia de Piauí. Metodología: El trabajo se desarrolló através de un análisis retrospectivo de las historias clínicas de mujeres embarazadas y puérperas de una Unidad de Cuidados Intensivos (UCI) de una maternidad pública de referencia de Teresina, Piauí, con diagnostico de Síndrome HELLP, de enero de 2016 a diciembre de 2018. El estudio incluyó la cuantificación de la modalidad de parto más utilizada para la interrupción del embarazo y el número de pacientes en las que ocurrieron interrupciones del embarazo. Se calcularon estadísticos descriptivos: media, desviación estándar, mínimo y máximo, para variables cuantitativas; y frecuencias, para variables cualitativas. En el análisis inferencial, se utilizaron las pruebas de Kolmogorov-Smirnov y t de Student para verificar la normalidad y comparación entre grupos, respectivamente, además, para las variables independientes cualitativas, se realizó la chi-cuadrado de Pearson. Resultados: De un total de 68, el 45,6% (31) de las mujeres presentaron al menos una complicación materna. Se identificaron seis (8,8%) muertes maternas. Las complicaciones más prevalentes fueron insuficiencia respiratoria aguda 10 (14,7%), insuficiencia renal aguda 10 (14,7%), infección 10 (14,7%), desprendimiento de placenta 9 (13,2%), coagulación 7 (10,3%) y 14 (20,6%). presentó aspectos de Near miss. Conclusión: La morbilidad de las gestantes y puérperas ingresadas en la UCI de la maternidad mencionada con diagnóstico de síndrome HELLP fue alta.
Citas
American College of Obstetricians and Gynecologists (ACOG). (2013). Hypertension in Pregnancy. Washington, DC.
Alese, M. O., Moodley, J., & Naicker, T. (2021). Preeclampsia and HELLP syndrome, the role of the liver. The Journal of Maternal-Fetal & Neonatal Medicine, 1–7.
Aloizos, S., Seretis, C., Liakos, N., Aravosita, P., Mystakelli, C., Kanna, E., & Gourgiotis, S. (2013). HELLP syndrome: Understanding and management of a pregnancy-specific disease. Journal of Obstetrics and Gynaecology, 33(4), 331–337.
Antwi, E., Amoakoh-Coleman, M., Vieira, D. L., Madhavaram, S., Koram, K. A., Grobbee, D. E., Agyepong, I. A., & Klipstein-Grobusch, K. (2020). Systematic review of prediction models for gestational hypertension and preeclampsia. PLoS ONE, 15(4).
Appenzeller, S., Souza, F. H. C., Wagner Silva de Souza, A., Shoenfeld, Y., & de Carvalho, J. F. (2011). HELLP Syndrome and Its Relationship with Antiphospholipid Syndrome and Antiphospholipid Antibodies. Seminars in Arthritis and Rheumatism, 41(3), 517–523.
Audibert, F., Friedman, S. A., Frangieh, A. Y., & Sibai, B. M. (1996). Clinical utility of strict diagnostic criteria for the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. American Journal of Obstetrics and Gynecology, 175(2), 460–464.
Azimi-Ghomi, O., Miller, G., Guida, C., Marimon, A., Boneva, D., & McKenney, M. (2021). HELLP! The Novel Use of Continuous Renal Replacement Therapy and Nitric Oxide in the Treatment of Acute Respiratory Failure in HELLP Syndrome. Case Reports in Critical Care, 2021, 1–4.
Baxter, J. K., & Weinstein, L. (2004). HELLP Syndrome: The State of the Art. Obstetrical & Gynecological Survey, 59(12), 838–845.
Borghese, M. M., Walker, M., Helewa, M. E., Fraser, W. D., & Arbuckle, T. E. (2020). Association of perfluoroalkyl substances with gestational hypertension and preeclampsia in the MIREC study. Environment International, 141(86), 105789.
Brasil. (2000). Gestação de alto risco: manual técnico. Ministério Da Saúde, Secretaria De Políticas Da Saúde. Coelho, T. M., Martins, M. da G., Viana, E., Mesquita, M. R. de S., Camano, L., & Sass, N. (2004). Proteinúria nas síndromes hipertensivas da gestação: prognóstico materno e perinatal. Revista Da Associação Médica Brasileira, 50(2), 207–213.
Brilhante, A. V. M., de Souza Vieira, L. J. E., de Oliveira Branco, J. G., de Castro, A. L., Catunda, A. V., Ribeiro, S. B., Lima, A. C. M. P. (2017). Maternal near miss as health care indicator: an integrative review. Revista Brasileira em Promocao da Saude, 30(4).
Ditisheim, A., & Sibai, B. M. (2017). Diagnosis and Management of HELLP Syndrome Complicated by Liver Hematoma. Clinical Obstetrics and Gynecology, 60(1), 190–197.
Dusse, L. M., Alpoim, P. N., Silva, J. T., Rios, D. R. A., Brandão, A. H., & Cabral, A. C. V. (2015). Revisiting HELLP syndrome. Clinica Chimica Acta, 451, 117–120.
Erkurt, M. A., Sarici, A., Kuku, I., Berber, I., Kaya, E., Bicim, S., Karaman, S., & Ozgul, M. (2021). The effect of therapeutic plasma exchange on management of HELLP Syndrome: The report of 47 patients. Transfusion and Apheresis Science: Official Journal of the World Apheresis Association: Official Journal of the European Society for Haemapheresis, 60(5), 103248.
França, C. M. V. (2010). A prevalência de gestantes portadoras de DHEG que apresentaram a síndrome HELLP em uma maternidade de referência de Maceió-AL [dissertação]. Maceió (AL): Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL).
Freitas, F. (2011). Rotinas em obstetrícia. In Rotinas em obstetrícia (pp. 624-624).
Giordano, J. C., Parpinelli, M. A., Cecatti, J. G., Haddad, S. M., Costa, M. L., Surita, F. G., Pinto e Silva, J. L., & Sousa, M. H. (2014). The Burden of Eclampsia: Results from a Multicenter Study on Surveillance of Severe Maternal Morbidity in Brazil. PLoS ONE, 9(5), e97401.
Guimarães, J. P., Medeiros, L. G., Oliveira, F. C. S., & Oliveira, S. F. (2014). A prevalência de gestantes portadoras de SHEG que evoluíram para síndrome HELLP em uma maternidade pública. Revista Brasileira de Educação e Saúde, 4(1), 1-17.
Gul, A., Cebeci, A., Aslan, H., Polat, I., Ozdemir, A., & Ceylan, Y. (2005). Perinatal Outcomes in Severe Preeclampsia-Eclampsia with and without HELLP Syndrome. Gynecologic and Obstetric Investigation, 59(2), 113–118.
Haram, K., Svendsen, E., & Abildgaard, U. (2009). The HELLP syndrome: clinical issues and management. A Review. BMC pregnancy and childbirth, 9, 8. https://doi.org/10.1186/1471-2393-9-8
Haram, K., Mortensen, J. H., & Nagy, B. (2014). Genetic Aspects of Preeclampsia and the HELLP Syndrome. Journal of Pregnancy, 2014, 1–13.
Haram, K., Mortensen, J. H., Mastrolia, S. A., & Erez, O. (2016). Disseminated intravascular coagulation in the HELLP syndrome: how much do we really know? The Journal of Maternal-Fetal & Neonatal Medicine, 30(7), 779–788.
Isler, C. M., Rinehart, B. K., Terrone, D. A., Martin, R. W., Magann, E. F., & Martin, J. N. (1999). Maternal mortality associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. American Journal of Obstetrics and Gynecology, 181(4), 924–928.
Kändler, C., Kevekordes, B., Zenker, M., Kandler, M., Beinder, E., Lang, N., & Harms, D. (1998). Prognosis of children born to mothers with HELLP-syndrome. Journal of Perinatal Medicine, 26(6), 486–490.
Katz, L., Amorim, M. M. R. de, Miranda, G. V., & Silva, J. L. P. e. (2008). Perfil clínico, laboratorial e complicações de pacientes com síndrome HELLP admitidas em uma unidade de terapia intensiva obstétrica. Revista Brasileira de Ginecologia E Obstetrícia, 30(2).
Khan, K. S., Wojdyla, D., Say, L., Gülmezoglu, A. M., & Van Look, P. F. (2006). WHO analysis of causes of maternal death: a systematic review. The Lancet, 367(9516), 1066–1074.
Kongwattanakul, K., Saksiriwuttho, P., Chaiyarach, S., & Thepsuthammarat, K. (2018). Incidence, characteristics, maternal complications, and perinatal outcomes associated with preeclampsia with severe features and HELLP syndrome. International Journal of Women’s Health, Volume 10, 371–377.
Krebs, V. A., Silva, M. R. da, & Bellotto, P. C. B. (2021). Síndrome de Hellp e Mortalidade Materna: Uma revisão integrativa / Hellp Syndrome and Maternal Mortality: An Integrative Review. Brazilian Journal of Health Review, 4(2), 6297–6311.
Lam, M. C., & Dierking, E. (2017). Intensive Care Unit issues in eclampsia and HELLP syndrome. International Journal of Critical Illness and Injury Science, 7(3), 136.
Lee, H., Yano, Y., Cho, S. M. J., Park, J. H., Park, S., Lloyd-Jones, D. M., & Kim, H. C. (2020). Cardiovascular Risk of Isolated Systolic or Diastolic Hypertension in Young Adults. Circulation, 141(22), 1778–1786.
Lisonkova, S., Razaz, N., Sabr, Y., Muraca, G., Boutin, A., Mayer, C., Joseph, K., & Kramer, M. (2020). Maternal risk factors and adverse birth outcomes associated with HELLP syndrome: a population‐based study. BJOG: An International Journal of Obstetrics & Gynaecology, 127(10), 1189–1198.
Liu, C.-M., Cheng, P.-J., & Chang, S.-D. (2008). Maternal Complications and Perinatal Outcomes Associated with Gestational Hypertension and Severe Preeclampsia in Taiwanese Women. Journal of the Formosan Medical Association, 107(2), 129–138.
MAGANN, E. F., & MARTIN, J. N. (1999). Twelve Steps to Optimal Management of HELLP Syndrome. Clinical Obstetrics and Gynecology, 42(3), 532.
Malmström, O., & Morken, N. H. (2019). HELLP Syndrome, Risk Factors in First and Second Pregnancy. Obstetric Anesthesia Digest, 39(1), 19–20.
Mecacci, F., Carignani, L., Cioni, R., Parretti, E., Mignosa, M., Piccioli, A., Scarselli, G., & Mello, G. (2001). Time Course of Recovery and Complications of HELLP Syndrome with Two Different Treatments: Heparin or Dexamethasone. Thrombosis Research, 102(2), 99–105.
Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews Nephrology, 16(4), 223–237.
Ngwenya, S. (2017). Severe preeclampsia and eclampsia: incidence, complications, and perinatal outcomes at a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe. International Journal of Women’s Health, Volume 9, 353–357.
Oliveira, L. C., & Costa, A. A. R. D. (2015). Near miss materno em unidade de terapia intensiva: aspectos clínicos e epidemiológicos. Revista Brasileira de Terapia Intensiva, 27, 220-227.
Oliveira, M. I. V. D., & Vasconcelos, S. G. (2006). Puérperas com síndrome de HELLP: análise baseada nos aspectos obstétricos.
Onoh, R. C., Onyebuchi, K. A., Mamah, J. E., Anozie, B. O., Kenneth, E. C., & Chidi, E. O. U. (2020). Obstetric outcome of pregnancies complicated by hypertensive disorders of pregnancy. Sahel Medical Journal, 23(3), 141.
Palmrich, P., Binder, C., Zeisler, H., Kroyer, B., Pateisky, P., & Binder, J. (2021). Awareness of obstetricians for long-term risks in women with a history of preeclampsia or HELLP syndrome. Archives of Gynecology and Obstetrics, 305(3), 581–587.
Pankiewicz, K., Szczerba, E., Maciejewski, T., & Fijałkowska, A. (2019). Non-obstetric complications in preeclampsia. Przegla̜d Menopauzalny= Menopause Review, 18(2), 99.
Paul, G., Gupta, S., Juneja, S., & Paul, B. (2013). Spectrum of neurological complications in HELLP syndrome. Neurology India, 61(5), 467.
Pauli, J. M., & Repke, J. T. (2017). Pitfalls With the New American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy. Clinical Obstetrics and Gynecology, 60(1), 141–152.
Peraçoli, J. C., & Parpinelli, M. A. (2005). Síndromes hipertensivas da gestação: identificação de casos graves. Revista Brasileira de Ginecologia E Obstetrícia, 27(10), 627–634.
Pereira, M. N., Montenegro, C. A. B., & Rezende Filho, J. (2008). Síndrome HELLP: diagnóstico e conduta. Femina, 111-116.
Piato, S. (2009). Complicações em obstetrícia. Sebastião Piato.
Rabinovich, A., Holtzman, K., Shoham-Vardi, I., Mazor, M., & Erez, O. (2019). Oligohydramnios is an independent risk factor for perinatal morbidity among women with pre-eclampsia who delivered preterm. The Journal of Maternal-Fetal & Neonatal Medicine: The Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 32(11), 1776–1782.
Ramos, J. G. L., Sass, N., & Costa, S. H. M. (2017). Preeclampsia. Revista Brasileira de Ginecologia e Obstetrícia, 39, 496-512.
Rana, S., Lemoine, E., Granger, J. P., & Karumanchi, S. A. (2019). Preeclampsia: pathophysiology, challenges, and perspectives. Circulation research, 124(7), 1094-1112.
Rebahi, H., Still, M. E., Faouzi, Y., & El Adib, A. R. (2018). Risk factors for eclampsia in pregnant women with preeclampsia and positive neurosensory signs. Turkish journal of obstetrics and gynecology, 15(4), 227.
Rimaitis, K., Grauslyte, L., Zavackiene, A., Baliuliene, V., Nadisauskiene, R., & Macas, A. (2019). Diagnosis of HELLP syndrome: a 10-year survey in a perinatology centre. International journal of environmental research and public health, 16(1), 109.
Ricci, S. S. (2015). Enfermagem materno-neonatal e saúde da mulher. Grupo Gen-Guanabara Koogan.
Rosendo, T. M. S. D. S., & Roncalli, A. G. (2016). Near miss materno e iniquidades em saúde: análise de determinantes contextuais no Rio Grande do Norte, Brasil. Ciência & Saúde Coletiva, 21, 191-201.
Saadat, M., Nejad, S. M., Habibi, G., & Sheikhvatan, M. (2007). Maternal and neonatal outcomes in women with preeclampsia. Taiwanese Journal of Obstetrics and Gynecology, 46(3), 255-259.
Sibai, B. M., Ramadan, M. K., Usta, I., Salama, M., Mercer, B. M., & Friedman, S. A. (1993). Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). American journal of obstetrics and gynecology, 169(4), 1000-1006.
Sibai, B. M., Taslimi, M. M., El-Nazer, A., Amon, E., Mabie, B. C., & Ryan, G. M. (1986). Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia-eclampsia. American journal of obstetrics and gynecology, 155(3), 501-507.
Soubhi Kahhale, & Zugaib, M. (1995). Sindromes hipertensivas na gravidez. São Paulo: Atheneu.
Simetka, O., Klat, J., Gumulec, J., Dolezalkova, E., Salounova, D., & Kacerovsky, M. (2015). Early identification of women with HELLP syndrome who need plasma exchange after delivery. Transfusion and Apheresis Science, 52(1), 54-59.
Singhal, N., Amin, H. J., Pollard, J. K., Tough, S. C., Johnston, D. W., Clark, D. J., & Sauve, R. (2004). Maternal haemolysis, elevated liver enzymes and low platelets syndrome: perinatal and neurodevelopmental neonatal outcomes for infants weighing less than 1250 g. Journal of paediatrics and child health, 40(3), 121-126.
Tanwar, R. S., Agarwal, D., Gupta, R. K., Rathore, V., Beniwal, P., Joshi, P., & Malhotra, V. (2018). Characteristics and outcome of postpartum acute kidney injury requiring dialysis: A single-center experience from North India. Saudi Journal of Kidney Diseases and Transplantation, 29(4), 837.
Timokhina, E., Kuzmina, T., Strizhakov, A., Pitskhelauri, E., Ignatko, I., & Belousova, V. (2019). Maternal cardiac function after normal delivery, preeclampsia, and eclampsia: a prospective study. Journal of pregnancy, 2019.
Maroto, V., ML, M. G., Marenco, M. L., & Castro de Gavilan, D. (2004). Clinical and biological characteristics of a group of 54 pregnant women with HELLP syndrome. Medicina Clinica, 122(7), 259-261.
Vaught, A. J., Braunstein, E., Chaturvedi, S., Blakemore, K., & Brodsky, R. A. (2020). A review of the alternative pathway of complement and its relation to HELLP syndrome: is it time to consider HELLP syndrome a disease of the alternative pathway. The Journal of Maternal-Fetal & Neonatal Medicine, 1-9.
Vieira, F. N., de Sousa, E. S., do Carmo Bastos, M., Vieira, F. N., de Carvalho Fonseca, N. S., & Vasconcelos, M. C. C. (2005). Complicações de pacientes obstétricas e puerperais admitidas em Unidade de Terapia Intensiva. RBTI, 17(4), 251-55.
Vigil-De Gracia, P. (2015). Síndrome Hellp. Ginecología y Obstetricia de México, 83(01), 48-57.
Wallace, K., Harris, S., Addison, A., & Bean, C. (2018). HELLP syndrome: pathophysiology and current therapies. Current pharmaceutical biotechnology, 19(10), 816-826.
Wang, C., Yuan, Y., Zheng, M., Pan, A. N., Wang, M., Zhao, M., ... & Xue, H. (2020). Association of age of onset of hypertension with cardiovascular diseases and mortality. Journal of the American College of Cardiology, 75(23), 2921-2930.
Weinstein, L. (1982). Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. American journal of obstetrics and gynecology, 142(2), 159-167.
World Health Organization. (2011). Evaluating the quality of care for severe pregnancy complications: the WHO near-miss approach for maternal health.
Yıldırım, G., Güngördük, K., Aslan, H., Gül, A., Bayraktar, M., & Ceylan, Y. (2011). Comparison of perinatal and maternal outcomes of severe preeclampsia, eclampsia, and HELLP syndrome. Journal of the Turkish German Gynecological Association, 12(2), 90.
Zugaib, M. (2012). Obstetrícia. Manole.
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2022 Marcelo Moreira Arêa Leão; Jose Arimateia dos Santos Junior
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Los autores que publican en esta revista concuerdan con los siguientes términos:
1) Los autores mantienen los derechos de autor y conceden a la revista el derecho de primera publicación, con el trabajo simultáneamente licenciado bajo la Licencia Creative Commons Attribution que permite el compartir el trabajo con reconocimiento de la autoría y publicación inicial en esta revista.
2) Los autores tienen autorización para asumir contratos adicionales por separado, para distribución no exclusiva de la versión del trabajo publicada en esta revista (por ejemplo, publicar en repositorio institucional o como capítulo de libro), con reconocimiento de autoría y publicación inicial en esta revista.
3) Los autores tienen permiso y son estimulados a publicar y distribuir su trabajo en línea (por ejemplo, en repositorios institucionales o en su página personal) a cualquier punto antes o durante el proceso editorial, ya que esto puede generar cambios productivos, así como aumentar el impacto y la cita del trabajo publicado.
