HELLP - SYNDROME IN OBSTETRIC PRACTICE

HELLP - syndrome is a severe complication of pregnancy characterized by a triad of symptoms. HELLP-syndrome among pregnant women with gestoses develops in 4-12% of cases, according to the generalized data of world literature in 2-20% of pregnancies. HELLP syndrome develops in the 3rd trimester of pregnancy at 33-35 weeks. In 30% of cases, it develops mainly up to 7 days, more often within 48 hours after childbirth and it is observe in multiparous women with gestoses, more often over the age of 25 years. To date, the pathogenesis of the syndrome has not been fully explore. Most likely, it develops with a combination of a number of factors, aggravated by the course of gestoses. The starting point in the development of HELLP-syndrome is a decrease in the production of prostacyclin against the background of an autoimmune reaction resulting from the effect of antibodies on blood cells and endothelium. This leads to microangiopathic changes in the inner lining of the vessels and the release of placental thromboplastin, which enters the mother's bloodstream. In parallel with damage to the endothelium, vasospasm occurs, provoking ischemia of the placenta. Thus, HELLP syndrome leads to an extreme degree of activation of the processes of systemic inflammation and organ damage, that is, multiple organ failure.

1. Pritchard J.A., Weisman R., Ratnoff O.D., Vosburgh G.J. Intravascular hemolysis, thrombocytopenia and other hematologic abnormalities associated with severe toxemia of pregnancy. N Engl J Med 1954; 250: 89.

2. Goodlin R.S. Preeclampsia as the great impostor. // Amer. J. Obstet. Gynecol., 1991, v.164, p. 1577-1581.

3. Weinstein L. Preeclampsia / eclampsia with hemolysis, elevated liver enzymes and trombocytopenia. // Obstet. Gynecol., 1985, v.66, p.657-660.

4. Hernandez C., Cunningham F.G. Eclampsia. // Clin. Obstet. Gynecol., 1990, v.33, p. 460-466.

5. Martin J.N., Files J.C., Blake P.G. ft al. Plasma exchange for preeclampsia I. Postpartum use persistently, severe preeclampsia - eclampsia with HELLP syndrome. // Amer. J. Obstet. Gynecol., 1990, v.162, p.126-137.

6. Van Dam P.A., Renier M., Baekelandt M. et al. Disseminated intravascular coagulation and the syndrome of hemolysis, elevated liver enzymes and low platelets in severe preeclampsia. // Obstet. Gynecol.,1989, V.73, p.97-102.

7. Martin J.N., Files J.C., Blake P.G. ft al. Plasmaexchange for preeclampsia I. Postpartum use persistently, severe preeclampsia- eclampsia with HELLP syndrome. // Amer. J. Obstet. Gynecol., 1990, v.162, p.126-137.

8. Brandenburg V.M., Frank R.D., Heintz В. et al. HELLP syndrome, multifactorial thrombophilia and postpartum myocardial infarction. J. Perinat. Med., 2004; 32 (2): 181-3.

9. Sullivan C.A. et al. The recurrence risk of the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP) in subsequent gestations // American journal of obstetrics and gynecology. – 1994. – Т. 171. – №. 4. – С. 940-943.

10. Sibai B.M. et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) // American journal of obstetrics and gynecology. – 1993. – Т. 169. – №. 4. – С. 1000-1006.

11. C. Benedetto, L. Marozio, A. Tancredi, et al. Biochemistry of HELLP syndrome. Adv. Clin. Chem., 53 (2011), pp. 85-104.

12. Timokhina E.V., Strizhakov A.N., Belousova V.S., Aslanov A.G., Bogomazova I.M., Afanasyeva N.V., Samoylova J.A., Ibragimova S.M., Kechina A.M. HELLPsyndrome as a life-threatening condition: current clinical considerations. Obstetrics, Gynecology and Reproduction. 2019; 13 (1):35-42. (In Russ.)