Eclampsia

Mehmet Armagan
Osmanagaoglu
Selen Osmanagaoglu
Hülya Ulusoy
Hasan Bozkaya

Department of Obstetrics and Gynecology, and Department of Anesthesiology
and Reanimation, Karadeniz Technical University, Trabzon, Turkey

INTRODUCTION
Maternal mortality, presented as a ratio,
measures obstetric risk per 100,000 live births
and has been defined internationally as the
total number of deathsof women during
pregnancy or within 42 days after the end of
pregnancy.1 Pregnancy-related hypertensive
disorders are the main cause of maternal mortality in most countries. Data from developed
countries show maternal mortality of about
0.1% due to preeclampsia, in which the majority of cases were complicated by the HELLP
syndrome (hemolysis, elevated liver enzymes
and low platelet count).1Despite the development of tertiary care facilities, intensive care
and advanced blood banking techniques, maternal and neonatal deaths continue to occur
in association with HELLP syndrome.2-4 The
reported maternal mortality due to HELLP
syndrome ranges from 0% to 24%.4
OBJECTIVE
In this present study our aim was to
determine maternal morbidity and mortality
among women with HELLP syndromewho
required transfer for critical care.
METHODS
This was a retrospective study carried
out within the Department of Obstetrics and
Gynecology and Department of Anesthesiology and Reanimation, School of Medicine,
Karadeniz Technical University, Trabzon,
Turkey.
All patients with HELLP syndrome (n =
37) admitted to the Department of Obstetrics and Gynecology between January 1992
and June2004 were analyzed retrospectively.
Shortly after delivery, all the patients were
cared for in the intensive care unit (ICU).
The clinical examination included temperature measurement, non-invasive pressure
monitoring, heart rate and urinary output,

Sao Paulo Med J. 2006;124(2):85-9.

and routine laboratory evaluations included
serial measurement of liver function tests,
complete bloodcell count, coagulation profile,
and renal function tests. Neurological examination included the utilization of the Glasgow
coma score (GCS), a widely used scoring system for quantifying the level of consciousness
following traumatic brain injury. It evaluates
the best eye opening response, verbal response
and motor response.
Computerized tomography or magnetic
resonance imaging wasperformed as indicated
by focal neurological signs such as recurrent
seizures after initiation of anticonvulsant therapy, coma and unusual behavioral changes.
Abdominal ultrasonography was performed
to investigate possible presence of subcapsular
liver hematoma or rupture, if indicated. Acute
renal failure was diagnosed in the presence of
oliguria or four hours of anuria in association
withseverely reduced renal function: raised
serum creatine (≥ 1.13 mg/dl) and serum urea
levels, and diminished creatinine clearance (≤
20 ml/min). Diagnoses of acute lung edema or
pleural effusion were utilized as determinants
of clinical status or radiological investigation
of the cases. Disseminated intravascular coagulation (DIC) was defined as the presence
of low platelets (< 100 x 109/l), lowfibrinogen
(< 300 mg/dl), prolonged prothrombin time
(≥ 14 sec), partial thromboplastin time ≥ 40
sec, and estimates of fibrinogen degradation
products or D-dimer ≥ 800 ng/ml.5 Gestational age was determined from the last
menstrual period, uterus size upon admission,
or early sonography, if obtained.
The diagnosis of HELLP syndrome was
made using the criteria established by Sibai,4
i .e.on the basis of hemolysis, abnormal
peripheral blood smear, increased lactic dehydrogenase (LDH) (> 600 U/I), increased total
bilirubin (> 1.2 mg/dl), elevated liver enzymes
[increased plasma aspartate amino transferase

ORIGINAL ARTICLE

Maternal outcome in HELLP
syndrome requiring intensive care
management in a Turkish hospital

ABSTRACT
C ONTEXT AND ObjECTIvE : D espite the de...