Abordaje terapéutico del síndrome HELLP

##plugins.themes.bootstrap3.article.main##

Rafaela Almeida Cassaniga
Bruna Lima de Almeida Teixeira
Carla Resende Vaz Oliveira
Bruno Cezario Costa Reis

Resumen

Objetivo: Analizar los diferentes abordajes terapéuticos, principalmente relacionados con el uso de corticoides, a realizar ante un paciente con síndrome HELLP.  Métodos: esta revisión integrativa de la literatura utilizó PubMed, Cochrane y Science Direct como plataformas electrónicas de investigación, eligiendo artículos publicados entre 2002 y 2021. Los descriptores utilizados fueron "síndrome HELLP", "terapia" y "manejo". Los criterios de inclusión fueron artículos de ensayos clínicos, aleatorizados o no aleatorizados, estudios de casos y controles, estudios de cohortes, acceso libre, publicados en inglés, portugués y español.  Resultados: Se seleccionaron 16 artículos, de un total de 1.340 artículos inicialmente identificados.  De los artículos analizados, se describió el uso de cuatro corticoides diferentes en el manejo del síndrome HELLP, siendo los dos más utilizados dexametasona y betametasona y los otros dos, menos utilizados, prednisolona y metilprednisolona.  Consideraciones finales: Entre los cuatro fármacos disponibles, la dexametasona se sugiere como el principal fármaco de elección para su administración en el puerperio, ya que redunda en mayores beneficios para la recuperación de la gestante.

##plugins.themes.bootstrap3.article.details##

Cómo citar
CassanigaR. A., TeixeiraB. L. de A., OliveiraC. R. V., & ReisB. C. C. (2023). Abordaje terapéutico del síndrome HELLP. Revista Eletrônica Acervo Médico, 23(5), e12540. https://doi.org/10.25248/reamed.e12540.2023
Sección
Revisão Bibliográfica

Citas

1. ALMEIDA WS, et al. Avaliação dos resultados neonatais e fatores associados em gestantes com pré-eclâmpsia grave: uma revisão sistemática. Revista Eletrônica Acervo Saúde, 2021; 13(2): e5799.

2. ASTUDILLO R, et al. Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health Expectant management in pregnant women with early and severe preeclampsia and concomitant risk factors. Pregnancy Hypertens An Int J Women’s Cardiovasc Heal, 2013; 3(4): 235–41.

3. BARNHART L. HELLP Syndrome and the Effects on the Neonate. Neo Network, 2015; 34(5): 269–73.
4. CAVAIGNAC-VITALIS M, et al. Conservative versus active management in HELLP syndrome: results from a cohort study. ST AC, 2017; 7058.
5. CLARKE DS e NELSON-PIERCY C. Pre-eclampsia and HELLP syndrome. Anaesth Intensive Care Med, 2008; 9(3): 110–4.
6. COELHO LMC e SIQUEIRA EC. Distúrbios hipertensivos na gravidez: pré-eclâmpsia, eclâmpsia e síndrome HELLP. Revista Eletrônica Acervo Saúde, 2022; 15(8): e10681.
7. FITZPATRICK KE, et al. Risk Factors, Management, and Outcomes of Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome and Elevated Liver Enzymes, Low Platelets Syndrome. Obstetrics & Gynecology, 2014; 123(3): 618–27.
8. FONSECA JE, et al. Dexamethasone for the treatment of class I HELLP syndrome: A double- blind, placebo-controlled, multicenter, randomized clinical trial. Pregnancy Hypertens, 2019; 17: 158–64.
9. HARAM K, et al. The HELLP syndrome: Clinical issues and management. BMC Pregnancy and Childbirth, 2009; 9(8): 1–15.
10. IOST ARJ, et al. Biomarcadores e pré-eclâmpsia: uma revisão integrativa. Revista Eletrônica Acervo Médico, 2022; 11: e10389.
11. KANG S, et al. Effectiveness of high-dose glucocorticoids on hemolysis, elevating liver enzymes, and reducing platelets syndrome. Journal of International Medical Research, 2018; 0(0): 1-10.
12. KATZ L, et al. COHELLP: collaborative randomized controlled trial on corticosteroids in HELLP syndrome. Reproductive Health Journal, 2013; 10(28): 1–6.
13. MACEDO MBB, et al. Síndrome de HELLP: parâmetros diagnósticos e tratamento oportuno. Revista Eletrônica Acervo Médico, 2022; 19: e11122.
14. MAGED AM, et al. Maternal, fetal and neonatal outcome among different types of hypertensive disorders associating pregnancy needing intensive care management. The Journal of Maternal-Fetal & Neonatal Medicine, 2018; 7058.
15. MAGED AM, et al. Maternal, fetal and neonatal outcome among different types of hypertensive disorders associating pregnancy needing intensive care management. The Journal of Maternal-Fetal & Neonatal Medicine, 2018; 7058.
16. MARIA L, et al. Revisiting HELLP syndrome. Clin Chim Acta, 2015; 451: 117–20.
17. MARTIN JN e MORRIS RF. Preeclampsia-Spectrum Hypertensive Disorders of Pregnancy: Gestational Hypertension, Preeclampsia, Eclampsia, Chronic Hypertension, and HELLP Syndrome. In: Sex Differences in Cardiovascular Physiology and Pathophysiology. Elsevier Inc, 2019; 121–36.
18. NUNES F, et al. CORTICOTERAPIA NA SÍNDROME DE HELLP (Hemólise, Enzimas Hepáticos Elevados e Trombocitopenia). Acta Med Port, 2004; 177–82.
19. O'BRIEN JM, et al. Maternal benefit of corticosteroid therapy in patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome: impact on the rate of regional anesthesia. Am J Obstet Gynecol, 2002; 186(3): 475-479.
20. OSMANAGAOGLU MA, et al. Maternal outcome in HELLP syndrome requiring intensive care management in a Turkish hospital. Sao Paulo Med J, 2006; 124(2): 85–9.
21. OZER A e SERDAR MK. The effects of betamethasone treatment on clinical and laboratory features of pregnant women with HELLP syndrome. Arch Gynecol Obstet., 2009; 65–70.
22. RUNNARD PJV, et al. A randomised placebo-controlled trial of prolonged prednisolone administration to patients with HELLP syndrome remote from term. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2006; 128: 187–93.
23. SHAHZAD N, et al. Comparison of dexamethasone versus betamethasone for the management of females with HELLP syndrome. Pakistan J Med Heal Sci, 2017; 11(2): 593–7.
24. SOUZA R, et al. Diagnóstico e conduta na Síndrome HELLP. Rev Med Minas Gerais, 2009; 19: 30–3.
25. STONE JH. Hospital HELLP Syndrome: Hemolysis, Elevated Liver Enzymes, and Low Platelets. JAMA, 1998; 280(6): 559–62.
26. TAKAHASHI A, et al. Effects of high-dose dexamethasone in postpartum women with class 1 haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. J Obstet Gynae (Lahore), 2018; 0(0): 1–5.
27. WALLACE K, et al. Seeking the mechanism (s) of action for corticosteroids in HELLP syndrome: SMASH study. YMOB, 2013; 208(5): 380.e1-380.e8.
28. WEINSTEIN L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: A severe consequence of hypertension in pregnancy. Am J Obstet Gynecol, 1982; 142(2): 159–67.

29. YILDIRIM G, et al. HELLP Syndrome: 8 Years of Experience from a Tertiary Referral Center in Western Turkey. Hypertens Pregnancy, 2012; 31(3): 316–26.