THE EFFECT OF DEXAMETHASONE TREATMENT ON MATERNAL OUTCOME IN HELLP SYNDROME

ÇETİNALP, Sibel; Tetiker, Sibel; KARATEKE, Faruk; ÖNCÜL SEYFETTİNOĞLU, Sevtap; ÖZDOĞAN KAYA, Hatice; NARİN, Raziye

THE EFFECT OF DEXAMETHASONE TREATMENT ON MATERNAL OUTCOME IN HELLP SYNDROME

Hatice ÖZDOĞAN KAYA, (Adana Numune Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, Adana, Türkiye)

Sevtap ÖNCÜL SEYFETTİNOĞLU, (Adana Numune Eğitim ve Araştırma Hastanesi, Kadın Hastalıkları ve Doğum Kliniği, Adana, Türkiye)

Sibel ÇETİNALP, (Adana Numune Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, Adana, Türkiye)

Faruk KARATEKE, (Adana Numune Eğitim ve Araştırma Hastanesi, Genel Cerrahi Kliniği, Adana, Türkiye)

Sibel TETİKER, (Adana Numune Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, Adana, Türkiye)

Raziye NARİN (Adana Numune Eğitim ve Araştırma Hastanesi, Kadın Hastalıkları ve Doğum Kliniği, Adana, Türkiye)

Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi

9 1

Yıl: 2019 Cilt: 52 Sayı: 1 Sayfa Aralığı: 8 - 12 Metin Dili: İngilizce İndeks Tarihi: 04-11-2020

THE EFFECT OF DEXAMETHASONE TREATMENT ON MATERNAL OUTCOME IN HELLP SYNDROME

Öz:

INTRODUCTION: There are still controversies in the literatureregarding the role of corticosteroids in the treatment of HELLPsyndrome. The aim of this study is to investigate the effect ofdexamethasone treatment on maternal outcome.MATERIALS AND METHODS: The study included 20 patientswho were followed in ICU with the diagnosis of HELLP syndrome.Data regarding the age, gestational age, Mississippi class, APACHEII score, hematologic and biochemical measurements, mortality andlength of ICU stay were analyzed retrospectively.RESULTS: Two patients died due to the multiple organ failure.Twelve patient received dexamethasone treatment (Group 1) andeight patients did not receive steroid treatment (Group 2). There wasnot any statistically significant difference in the length of ICU stay,mortality, and transfusion requirements between the groups. Thepatients receiving dexamethasone treatment showed an increasedimprovement in platelet count; however the difference was notstatistically significant.CONCLUSIONS: Dexamethasone treatment did not result in anyimprovement in mortality, length of ICU stay, and in the plateletcounts in patients with HELLP syndrome.

Anahtar Kelime:

HELLP SENDROMUNDA DEKSAMETAZON TEDAVİSİNİN MATERNAL SONUÇLAR ÜZERİNE ETKİSİ

Öz:

AMAÇ: Literatürde HELLP sendromunun tedavisinde kortikosteroid kullanımı ile ilgili çelişkili bilgiler bulunmaktadır. Bu çalışmanın amacı deksametazon tedavisinin maternal sonuçlar üzerindeki etkisinin araştırılmasıdır. YÖNTEMLER: Çalışmaya HELLP sendromu tanısı ile yoğun bakım ünitesinde izlenen 20 hasta dahil edilmiştir. Hasta yaşı, gestasyonel yaş, Mississipi sınflandırması, APACHE II skoru, hematolojik ve biyokimyasal ölçümler, mortalite ve yoğun bakım yatış günü gibi parametreler analiz edilmiştir. BULGULAR: Hastalardan ikisi çoklu organ yetmezliğine bağlı olarak ölmüştür. On iki hastaya deksametazon tedavisi verilmiş (Grup 1), 8 hasta ise kortikosteroid tedavisi almamıştır. Gruplar arasında yoğun bakım yatış süresi, transfüzyon gereksinimi ve mortalite açısından anamlı fark saptanmamıştır. Deksametazon tedavisi verilen grupta trombosit sayılarında artış daha fazla gerçekleşmiştir ancak bu artış istatistiksel fark yaratacak düzeyde olmamıştır. SONUÇ: HELLP sendromu tedavisinde dekzametazon kullanımı mortalite, yoğun bakım yatış günü ve trombosit sayılarında anlamlı bir fark yaratmamaktadır.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1.)Geary M. The HELLP syndrome. Br J Obstet Gynaecol 1997; 104: 887-891.
2.)Sibai BM, Taslimi MM, el-Nazer A, Amon E, Mabie BC, Ryan GM. Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia-eclampsia. Am J Obstet Gynecol 1986; 155(3): 501-9.
3.)Sibai BM. The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): much ado about nothing? Am J Obstet Gynecol 1990; 162:311-316.
4.)Benedetto C, Marozio L, Tancredi A, Picardo E, Nardolillo P, Tavella AM, Salton L. Biochemistry of HELLP syndrome. Adv Clin Chem 2011; 53: 85-104.
5.)Abildgaard U, Heimdal K. Pathogenesis of the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP): a review. Eur J Obstet Gynecol Reprod Biol 2013; 166: 117-123
6.)Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: Clinical issues and management. A Review. BMC Pregnancy and Childbirth 2009; 9:8 doi:10.1186/1471-2393-9-8
7.)Hemant K, Chabi S, Frey D. Hellp syndrome. J Obstet Gynecol India 2009; 59: 30-40
8.)Martin JN Jr, Rose CH, Briery CM. Understanding and managing HELLP syndrome: the integral role of aggressive glucocorticoids for mother and child. Am J Obstet Gynecol 2006; 195: 914-934.
9.)Martin JN Jr, Thigpen BD, Rose CH, Cushman J, Moore A, May WL. Maternal benefit of high-dose intravenous corticosteroid therapy for HELLP syndrome. Am J Obstet Gynecol 2003; 189: 830-834.
10.)O'Brien JM1, Shumate SA, Satchwell SL, Milligan DA, Barton JR. 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; 186:475-479.
11.)Yang L, Ren C, Mao M, Cui S. Prognostic Factors of the Efficacy of High-dose Corticosteroid Therapy in Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome During Pregnancy: A Meta-analysis. Medicine (Baltimore). 2016; 95(13):e3203.
12.)Mao M, Chen C. Corticosteroid Therapy for Management of Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) Syndrome: A Meta-Analysis. Med Sci Monit. 2015 Dec 3;21:3777-83.
13.)Noel ML, Brady CW. Liver disease in pregnancy. World J Gastroenterol 2009; 15: 897-906
14.)Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes and low platelet count. Obstet Gynecol 2004; 103: 981-991.
15.)Fonseca JE, Mendez F, Catano C, Arias F. Dexamethasone treatment does not improve the outcome of women with HELLP syndrome: a doubleblind, placebo-controlled, randomized clinical trial. Am J Obstet Gynecol 2005; 193: 1591-1598.
16.)Thiagarajah S, Bourgeois FJ, Harbert GM Jr, Caudle MR. Thrombocytopenia in preeclampsia: associated abnormalities and management principles. Am J Obstet Gynecol 1984; 150: 1-7.
17.)van Runnard Heimel PJ, Franx A, Schobben AF, Huisjes AJ, Derks JB, Bruinse HW. Corticosteroids, pregnancy, and HELLP syndrome: a review. Obstet Gynecol Surv 2005; 60: 57-70.
18.)Wallace K, Martin JN Jr, Tam Tam K, Wallukat G, Dechend R, Lamarca B, Owens MY. Seeking the mechanism(s) of action for corticosteroids in HELLP syndrome: SMASH study. Am J Obstet Gynecol. 2013; 208:380.e1-8.
19.)Magann EF, Bass D, Chauhan SP, Sullivan DL, Martin RW, Martin JN Jr. Antepartum corticosteroids: disease stabilization in patients with the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). Am J Obstet Gynecol 1994; 171: 1148-1153.
20.)Magann EF, Perry KG Jr, Meydrech EF, Harris RL, Chauhan SP, Martin JN Jr. Postpartum corticosteroids: accelerated recovery from the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). Am J Obstet Gynecol 1994; 171: 1154-1158.
21.)O'Brien JM, Shumate SA, Satchwell SL, Milligan DA, Barton JR. 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: 475-479.
22.)Rose CH, Thigpen BD, Bofill JA, Cushman J, May WL, Martin JN Jr. Obstetric implications of antepartum corticosteroid therapy for HELLP syndrome. Obstet Gynecol 2004; 104: 1011-1014.
23.)Vigil-De GP, Garcia-Caceres E. Dexamethasone in the postpartum treatment of HELLP syndrome. Int J Gynaecol Obstet 1997; 59: 217-221.
24.)Yalcin OT, Sener T, Hassa H, Ozalp S, Okur A. Effects of postpartum corticosteroids in patients with HELLP syndrome. Int J Gynaecol Obstet 1998; 61: 141-148.
25.)Qureshi NS, Tomlinson AJ. Prenatal corticosteroid therapy for elevated liver enzyme/low platelet count syndrome: a case report. J Reprod Med 2005; 50: 64-66.
26.)Woudstra DM, Chandra S, Hofmeyr GJ, Dowswell T. Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD008148. doi: 10.1002/14651858.CD008148.pub2.

APA	ÖZDOĞAN KAYA H, ÖNCÜL SEYFETTİNOĞLU S, ÇETİNALP S, KARATEKE F, Tetiker S, NARİN R (2019). THE EFFECT OF DEXAMETHASONE TREATMENT ON MATERNAL OUTCOME IN HELLP SYNDROME. , 8 - 12.
Chicago	ÖZDOĞAN KAYA Hatice,ÖNCÜL SEYFETTİNOĞLU Sevtap,ÇETİNALP Sibel,KARATEKE Faruk,Tetiker Sibel,NARİN Raziye THE EFFECT OF DEXAMETHASONE TREATMENT ON MATERNAL OUTCOME IN HELLP SYNDROME. (2019): 8 - 12.
MLA	ÖZDOĞAN KAYA Hatice,ÖNCÜL SEYFETTİNOĞLU Sevtap,ÇETİNALP Sibel,KARATEKE Faruk,Tetiker Sibel,NARİN Raziye THE EFFECT OF DEXAMETHASONE TREATMENT ON MATERNAL OUTCOME IN HELLP SYNDROME. , 2019, ss.8 - 12.
AMA	ÖZDOĞAN KAYA H,ÖNCÜL SEYFETTİNOĞLU S,ÇETİNALP S,KARATEKE F,Tetiker S,NARİN R THE EFFECT OF DEXAMETHASONE TREATMENT ON MATERNAL OUTCOME IN HELLP SYNDROME. . 2019; 8 - 12.
Vancouver	ÖZDOĞAN KAYA H,ÖNCÜL SEYFETTİNOĞLU S,ÇETİNALP S,KARATEKE F,Tetiker S,NARİN R THE EFFECT OF DEXAMETHASONE TREATMENT ON MATERNAL OUTCOME IN HELLP SYNDROME. . 2019; 8 - 12.
IEEE	ÖZDOĞAN KAYA H,ÖNCÜL SEYFETTİNOĞLU S,ÇETİNALP S,KARATEKE F,Tetiker S,NARİN R "THE EFFECT OF DEXAMETHASONE TREATMENT ON MATERNAL OUTCOME IN HELLP SYNDROME." , ss.8 - 12, 2019.
ISNAD	ÖZDOĞAN KAYA, Hatice vd. "THE EFFECT OF DEXAMETHASONE TREATMENT ON MATERNAL OUTCOME IN HELLP SYNDROME". (2019), 8-12.

APA	ÖZDOĞAN KAYA H, ÖNCÜL SEYFETTİNOĞLU S, ÇETİNALP S, KARATEKE F, Tetiker S, NARİN R (2019). THE EFFECT OF DEXAMETHASONE TREATMENT ON MATERNAL OUTCOME IN HELLP SYNDROME. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi, 52(1), 8 - 12.
Chicago	ÖZDOĞAN KAYA Hatice,ÖNCÜL SEYFETTİNOĞLU Sevtap,ÇETİNALP Sibel,KARATEKE Faruk,Tetiker Sibel,NARİN Raziye THE EFFECT OF DEXAMETHASONE TREATMENT ON MATERNAL OUTCOME IN HELLP SYNDROME. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi 52, no.1 (2019): 8 - 12.
MLA	ÖZDOĞAN KAYA Hatice,ÖNCÜL SEYFETTİNOĞLU Sevtap,ÇETİNALP Sibel,KARATEKE Faruk,Tetiker Sibel,NARİN Raziye THE EFFECT OF DEXAMETHASONE TREATMENT ON MATERNAL OUTCOME IN HELLP SYNDROME. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi, vol.52, no.1, 2019, ss.8 - 12.
AMA	ÖZDOĞAN KAYA H,ÖNCÜL SEYFETTİNOĞLU S,ÇETİNALP S,KARATEKE F,Tetiker S,NARİN R THE EFFECT OF DEXAMETHASONE TREATMENT ON MATERNAL OUTCOME IN HELLP SYNDROME. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. 2019; 52(1): 8 - 12.
Vancouver	ÖZDOĞAN KAYA H,ÖNCÜL SEYFETTİNOĞLU S,ÇETİNALP S,KARATEKE F,Tetiker S,NARİN R THE EFFECT OF DEXAMETHASONE TREATMENT ON MATERNAL OUTCOME IN HELLP SYNDROME. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. 2019; 52(1): 8 - 12.
IEEE	ÖZDOĞAN KAYA H,ÖNCÜL SEYFETTİNOĞLU S,ÇETİNALP S,KARATEKE F,Tetiker S,NARİN R "THE EFFECT OF DEXAMETHASONE TREATMENT ON MATERNAL OUTCOME IN HELLP SYNDROME." Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi, 52, ss.8 - 12, 2019.
ISNAD	ÖZDOĞAN KAYA, Hatice vd. "THE EFFECT OF DEXAMETHASONE TREATMENT ON MATERNAL OUTCOME IN HELLP SYNDROME". Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi 52/1 (2019), 8-12.