MATERNAL AND FETAL OUTCOMES IN HELLP SYNDROME AT 23 WEEKS GESTATION: SYSTEMATIC REVIEW
DOI:
https://doi.org/10.61841/1v9jdw27Keywords:
Early gestation, HELLP syndrome, maternal hypertension, preeclampsiaAbstract
Introduction: Hypertensive disorders, affecting 5-10% of pregnancies, are a leading cause of maternal and perinatal mortality. Preeclampsia-eclampsia, a syndrome contributing to significant global deaths, demands prompt identification and management, particularly in resource-limited settings. Detecting and addressing early and late-onset preeclampsia are crucial for maternal and neonatal well-being. HELLP syndrome, a severe complication of preeclampsia, presents diverse symptoms and risks, with a maternal mortality rate as high as 24%. Understanding its outcomes in pregnancies before 23 weeks is essential to guide better management strategies for improved maternal and neonatal health in such critical cases.
Methods: The researchers in this study followed the 2020 Preferred Reporting Items for Systematic Review and MetaAnalysis (PRISMA) guidelines to ensure that their work met the required standards. This was done to ensure the precision and reliability of the conclusions derived from the research.
Result: Our search produced 15 results. After looking at the titles and summaries, we found 6 papers that fit our criteria. At first, we excluded one articles because they were written in a review style. But after reading the full papers carefully, we included four papers in our final analysis. These papers included a retrospective observational study and several case reports.
Conclusion: Occurrences of HELLP syndrome without associated hypertensive disorders and recurrent intrahepatic ruptures at extremely premature gestational ages are rare but pose significant risks to mothers and newborns. Swift diagnosis, pregnancy termination, and continuous monitoring are crucial to address early-onset HELLP syndrome, emphasizing the need for immediate attention and prompt management.
References
Magee LA, Brown MA, Hall DR, Gupte S, Hennessy A, Karumanchi SA, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens [Internet]. 2022;27(September 2021):148–69. Available from: doi: 10.1016/j.preghy.2021.09.008
Duhig K, Vandermolen B, Shennan A. Recent advances in the diagnosis and management of pre-eclampsia. F1000Res. 2018;7:242. Published 2018 Feb 28. doi:10.12688/f1000research.12249.1
Khalid F, Mahendraker N, Tonismae T. HELLP Syndrome. [Updated 2023 Jul 29]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560615/
Wadhwani P, Saha PK, Kalra JK, Gainder S, Sundaram V. A study to compare maternal and perinatal outcome in early vs. late onset preeclampsia. Obstet Gynecol Sci. 2020;63(3):270–7. doi: 10.5468/ogs.2020.63.3.270 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Matthew H. Mossayebi, Neel S. Iyer, Rodney A. McLaren, Hind N. Moussa, Baha M. Sibai, Huda B. Al-Kouatly, HELLP syndrome at <23 weeks’ gestation: a systematic literature review, American Journal of Obstetrics and
Gynecology, Volume 229, Issue 5, 2023, Pages 502-515.e10, ISSN 0002-9378, https://doi.org/10.1016/j.ajog.2023.04.046.
(https://www.sciencedirect.com/science/article/pii/S0002937823002843) Abstract: Objective
Mark, K., Flanagan, N., Hurvitz, J., & Chawla, K. (2021). Abortion in women with severe preeclampsia and eclampsia prior to 24 weeks gestation. Contraception, 103(6), 420–422. doi:10.1016/j.contraception.2021.01.012 10.1016/j.contraception.2021.01.012
Kascak P, Paskala M, Antal P, Gajdosik R. Recurrent HELLP Syndrome at 22 Weeks of Gestation. Case Rep Obstet Gynecol. 2017;2017:9845637. doi:10.1155/2017/9845637
Ugonna Aja-Okorie, Nnabuike Chibuoke Ngene, Atypical preeclampsia-eclampsia syndrome at 18 weeks of gestation: A case report, Case Reports in Women's Health, Volume 36, 2022, e00470, ISSN 2214-9112, https://doi.org/10.1016/j.crwh.2022.e00470.
(https://www.sciencedirect.com/science/article/pii/S221491122200090X)
Han GH, Kim MA. Recurrent spontaneous hepatic rupture in pregnancy: A case report. Medicine (Baltimore). 2018;97(29):e11458. doi:10.1097/MD.0000000000011458
World Health Organization Safe abortion: technical and policy guidance for health systems. 2nd ed; 2012 https://apps.who.int/iris/bitstream/handle/10665/ 70914/9789241548434 _ eng.pdf?sequence=1 accessed December 17, 2020 .
P, W. A., Ernawati, E., & Susanti, D. (2016). CHARACTERISTICS OF HELLP SYNDROME IN SEVERE
PREECLAMPSIA PATIENTS IN DR. SOETOMO HOSPITAL SURABAYA. Folia Medica Indonesiana,
(4), 272–276. https://doi.org/10.20473/fmi.v51i4.2858
Tschann, Mary; Edelman, Alison; Jensen, Jeffrey; Bednarek, Paula; Kaneshiro, Bliss (2017). Blood loss at the
time of dilation and evacuation at 16 to 22 weeks of gestation in women using low molecular weight heparin: a case series. Contraception, (), S001078241730433X–. doi:10.1016/j.contraception.2017.09.002
O. Simetka, I. Michalec, H. Zewdiov´a, R. Kol´aˇrov´a, J. Proch´azkov´a, and M. Proch´azka, “Course and delivery outcomes of 34 pregnancies complicated by HELLP syndrom,” Ceska Gynekologie, vol. 75, no. 3, pp. 242–247, 2010.
I. P. M. Gaugler-Senden, A. G. Huijssoon, W. Visser, E. A. P. Steegers, and C. J. M. de Groot, “Maternal and perinatal outcome of preeclampsia with an onset before 24 weeks’ gestation. Audit in a tertiary referral center,” European Journal of Obstetrics Gynecology and Reproductive Biology, vol. 128, no. 1-2, pp. 216–221, 2006.
S. M. Jenkins, B. B. Head, and J. C. Hauth, “Severe preeclampsia at <25 weeks of gestation: maternal and neonatal outcomes,” American Journal of Obstetrics & Gynecology, vol. 186, no. 4, pp. 790–795, 2002.
W. M. Merz and U. Gembruch, “Severe, early-onset hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome episode with spontaneous remission during pregnancy,” Journal ofMaternal-Fetal and Neonatal Medicine, vol. 20, no. 8, pp. 631- 632, 2007.
Roelofsen AC, van Pampus MG, Aarnoudse JG (2003). The HELLP-syndrome; maternal-fetal outcome and follow up infants. Journal Perinatal Medicine 31, 201- 208
Erkilinc S and Eyi EGY (2013). Adolescent pregnancies complicated by HELLP syndrome: clinical experience of 26 cases. The Journal of Gynecology- Obstetrics and Neonatology 10, 1643-1646
N.C. Ngene, J. Moodley, Blood pressure measurement in pregnancy and preeclampsia: devices, techniques, and challenges, Cardiovasc. J. Afr. 30 (20) (2019) 120–129.
L.A. Magee, G.N. Smith, C. Bloch, A.-M. Cˆot´e, V. Jain, K. Nerenberg, P. von Dadelszen, M. Helewa, E. Rey, Guideline No, 426: Hypertensive disorders of pregnancy: diagnosis, prediction, prevention, and management, J. Obstet. Gynaecol. Can. 44 (5) (2022).
L.A. Magee, M.A. Brown, D.R. Hall, S. Gupte, A. Hennessy, S.A. Karumanchi, L. C. Kenny, F. McCarthy, J. Myers, L.C. Poon, S. Rana, S. Saito, A.C. Staff, E. Tsigas, P. von Dadelszen, The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice, Pregnancy Hypertens 27 (2022) 148–169.
Society for Maternal-Fetal Medicine (SMFM), J.M. Louis, J. Parchem, A. Vaught, M. Tesfalul, A. Kendle, E. Tsigas, (Preeclampsia Foundation), Preeclampsia: a report and recommendations of the workshop of the Society for Maternal-Fetal Medicine and the Preeclampsia Foundation, Am. J. Obstet. Gynecol. 227 (5) (2022) B2–B24.
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