Keywords
Therapy
Pregnancy
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Abstract
Objective: Analyze the different therapeutic approaches, mainly related to the use of corticosteroids, to be taken in the face of a patient with HELLP syndrome. Methods: This integrative literature review used PubMed, Cochrane and Science Direct as electronic research platforms, choosing articles published between 2002 and 2021. The descriptors used were “HELLP syndrome”, “therapy” and “management”. Inclusion criteria were articles from clinical trials, randomized or non-randomized, case-control studies, cohort studies, free access, published in English, Portuguese, Spanish. Results: 16 articles were selected, out of a total of 1,340 articles initially identified. Of the analyzed articles, the use of four different corticosteroids in the management of HELLP syndrome were described, the two most used being dexamethasone and betamethasone and the other two, less used, prednisolone and methylprednisolone. Final considerations: Among the four drugs available, dexamethasone is suggested as the main drug of choice for administration in the postpartum period, since it results in greater benefits for the recovery of the pregnant woman.
References
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.
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.
BARNHART L. HELLP Syndrome and the Effects on the Neonate. Neo Network, 2015; 34(5): 269–73.
CAVAIGNAC-VITALIS M, et al. Conservative versus active management in HELLP syndrome: results from a cohort study. ST AC, 2017; 7058.
CLARKE DS e NELSON-PIERCY C. Pre-eclampsia and HELLP syndrome. Anaesth Intensive Care Med, 2008; 9(3): 110–4.
COELHO LMC e SIQUEIRA EC. Distúrbios hipertensivos na gravidez: pré-eclâmpsia, eclâmpsia e síndrome HELLP. Revista Eletrônica Acervo Saúde, 2022; 15(8): e10681.
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.
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.
HARAM K, et al. The HELLP syndrome: Clinical issues and management. BMC Pregnancy and Childbirth, 2009; 9(8): 1–15.
IOST ARJ, et al. Biomarcadores e pré-eclâmpsia: uma revisão integrativa. Revista Eletrônica Acervo Médico, 2022; 11: e10389.
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.
KATZ L, et al. COHELLP: collaborative randomized controlled trial on corticosteroids in HELLP syndrome. Reproductive Health Journal, 2013; 10(28): 1–6.
MACEDO MBB, et al. Síndrome de HELLP: parâmetros diagnósticos e tratamento oportuno. Revista Eletrônica Acervo Médico, 2022; 19: e11122.
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.
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.
MARIA L, et al. Revisiting HELLP syndrome. Clin Chim Acta, 2015; 451: 117–20.
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.
NUNES F, et al. CORTICOTERAPIA NA SÍNDROME DE HELLP (Hemólise, Enzimas Hepáticos Elevados e Trombocitopenia). Acta Med Port, 2004; 177–82.
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.
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.
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.
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.
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.
SOUZA R, et al. Diagnóstico e conduta na Síndrome HELLP. Rev Med Minas Gerais, 2009; 19: 30–3.
STONE JH. Hospital HELLP Syndrome: Hemolysis, Elevated Liver Enzymes, and Low Platelets. JAMA, 1998; 280(6): 559–62.
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.
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.
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.
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.