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Leberpathologie im rahmen des HELLP-syndroms

  • 1. Hauptthema/Premier Thème Principal Lebererkrankungen In Der Schwangerschaft Pathologie Hépatique Et Grossesse
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Abstract

Liver pathology is one of the main features of HELLP syndrome and develops on the basis of a generalised activation of intravascular coagulation. Fibrin deposits and haemorrhagic necrosis predominantly develop in the periportal areas and may eventually lead to subcapsular haematomas or even rupture of the liver. While the compensated form of activation of intravascular coagulation, which is diagnosed by a decrease in antithrombin III and an increase in thrombinantithrombin III complex (TAT) and the appearance of fibrin, monomers andd-dimers, is found in almost all cases of HELLP syndrome, the decompensated form of intravascular coagulation with prolonged bleeding time (PT, PTT) and drop in fibrinogen is found only in the most severe forms. The development of a decompensation of coagulation correlates with the appearance of severe complications such as liver haematoma, abruptio placentae, renal failure and pulmonary oedema. The best prophylaxis against the development of life-threatening complications is early diagnosis and termination of pregnancy after stabilisation of the maternal condition, consisting of magnesium sulphate infusion, antihypertensive treatment with dihydralazin or calcium antagonists, steroids etc. Severe complications of HELLP syndrome have occasionally been observed in the postpartum period. As prophylaxis against postpartal worsening of HELLP syndrome, curettage of the uterus and continuation of the treatment with calcium antagonists and dexamethasone have been recommended.

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Literatur

  1. Arnoudse JG, Houthoft HJ, Weits J, Vellenga E, Huisjes HJ (1986) A syndrome of liver damage and intravascular coagulation in the last trimester of normotensive pregnancy. A clinical and histopathological study. Br J Obstet Gynaecol 93:145–155

    Google Scholar 

  2. Barton JR, Riely CA, Adamec TA, Shanklin DR, Khoury AD, Sibai BM (1992) Hepatic histopathologic condition does not correlate with laboratory abnormalities in HELLP-syndrome (hemolysis, elevated liver enzymes and low platelet count). Am J Obstet Gynecol 167:1538–1543

    CAS  PubMed  Google Scholar 

  3. Belfort M, Saade G, Kruz A, Adam K, Kirshon B, Kramer W, Moise K (1994) Nimodipine as an alternative to magnesiumsulfate in the management of severe pre-eclampsia: Maternal and fetal effects. Am J Obstet Gynecol 170:412

    Google Scholar 

  4. Benacerraf BR, Frigoletto FD, Martini CA (1985) Sonographic findings in severe pre-eclampsia 24 hours prior to clinical signs. Am J Obstet Gynecol 152:684–685

    CAS  PubMed  Google Scholar 

  5. De Bore K, Büller HR, Ten Cate YW, Treffers PE (1991) Coagulation studies in the syndrome of hemolysis, elevated liver enzymes and low platelets. Br J Obstet Gynaecol 98:42–47

    Google Scholar 

  6. Fenakel K, Fenakel G, Appelman Z, Lurie S, Katz S, Shoman Z (1991) Nifedipine in the treatment of severe preeclampsia. Obstet Gynecol 77:331–337

    CAS  PubMed  Google Scholar 

  7. Goodlin RC (1976) Severe pre-eclampsia: Another great imitator. Am J Obstet Gynecol 125:747–752

    CAS  PubMed  Google Scholar 

  8. Kennedy S, Hall P, Seymour AE, Hague WM (1994) Transient diabetes insipidus and acute fatty liver of pregnancy. Br J Ostet Gynaecol 101:387–391

    CAS  Google Scholar 

  9. Kronthal AJ, Fishman EK, Kuhlman JE, Bohlman ME (1990) Hepatic infarction in preeclampsia. Radiology 177:726–728

    CAS  PubMed  Google Scholar 

  10. Kurzel RB, Rooholamini SA, Au A (1994) Computerized tomographic (CT) findings in the HELLP syndrome. Am J Obstet Gynecol 170:407

    Google Scholar 

  11. Magann EF, Bass D, Chauhan SP, Perry KG, Morrison JC, Martin JN (1994) Accelerated recovery from severe pre-eclampsia. Uterine curettage versus nifedipine. SGI O98

  12. Magann EF, Bass D, Chauhan SP, Sullvian DL, Martin RW, Martin JN (1994) Antepartum corticosteroids: Disease stabilisation in patients with HELLP syndrome. Am J Obstet Gynecol 170:410

    Google Scholar 

  13. Magann EF, Martin JN, Isaacs JD, Perry KG, Martin RW, Meydrech EF (1993) Immediate postpartum curettage: Accelerated recovery from severe preeclampsia. Obstet Gynecol 81:502–506

    CAS  PubMed  Google Scholar 

  14. Magann EF, Perry KG, Poist JE, Harris RL, Norman PF, Martin JN (1994) Postpartum corticosteroids: Accelerated recovery from HELLP syndrome. Am J Obstet Gynecol 170:410

    Google Scholar 

  15. Martin JN, Blake PG, Perry KG, McCaul JF, Hess LW, Martin RW (1991) The natural history of HELLP-syndrome: Patterns of disease progression and regression. Am J Obstet Gynecol 164:1500–1513

    PubMed  Google Scholar 

  16. Martin JN, Files JC, Blake PG, Normann PH, Martin RW, Hess LW, Morrison JC, Wiser WL (1990) Plasma exchange for preeclampsia. I. Postpartum utilization for persistently severe preeclampsia (eclampsia with HELLP syndrome). Am J Obstet Gynecol 162:126–137

    PubMed  Google Scholar 

  17. Poldre PA (1987) Haptoglobin helps diagnose the HELLP-syndrome. Am J Obstet Gynecol 157:1267

    CAS  PubMed  Google Scholar 

  18. Pritchard JA, Weisman JR, Ratnoff OD, Vosburgh GJ (1954) Intravascular hemolysis, thrombocytopenia and other hematologic abnormalities associated with severe toxemia of pregnancy. New Engl J Med 250:89–92

    CAS  PubMed  Google Scholar 

  19. Rath W, Loos W, Kuhn W, Graeff H (1990) The importance of early laboratory screening methods for maternal and fetal outcome in cases of HELLP-syndrome. Eur J Obstet Gynecol Reprod Biol 36:43–51

    Article  CAS  PubMed  Google Scholar 

  20. Reyes H, Sandoval L, Wainstein A, Ribaltar J, Donoso S, Smok G, Rosenberg H, Meneses M (1994) Acute fatty liver of pregnancy: A clinical study of 12 episodes in 11 patients. Gut 35:101–106

    CAS  PubMed  Google Scholar 

  21. Riely CA, Latham PS, Romero R, Duffy TP (1987) Acute fatty liver of pregnancy — a reassessment based on observations in 9 patients. Ann Int Med 106:703–706

    CAS  PubMed  Google Scholar 

  22. Roberts JM, Redman CHWG (1993) Pre-eclampsia: More than pregnancy-induced hypertension. Lancet 341:1447–1451

    CAS  PubMed  Google Scholar 

  23. Roberts WE, Perry KG, Woods JB, Files JC, Blake PG, Martin JN (1994) The intrapartum platelet count in HELLP syndrome patients: Is it predictive of later hemorrhagic complications? SGI P393

  24. Rolfes DB, Ischak KG (1985) Acute fatty liver of pregnancy: A clinicopathologic study of 35 cases. Hepatology 5:1149–1158

    CAS  PubMed  Google Scholar 

  25. Schorr-Lesnick B, Lebovics E, Dwokin B, Rosenthal SW (1991) Liver diseases unique to pregnancy. Am J Gastroenterol 86:659–670

    CAS  PubMed  Google Scholar 

  26. Schrocksnadel H, Sitte B, Steckel-Berger G, Dapunt O (1992) Hemolysis in hypertensive disorders of pregnancy. Gynecol Obstet Invest 34:211–216

    CAS  PubMed  Google Scholar 

  27. Schwartz ML, Brenner W (1985) Severe preeclampsia with persistent postpartum hemolysis and thrombozytopenia treated by plasmapheresis. Obstet Gynecol 65:535

    Google Scholar 

  28. Sibai BM, Akl S, Fairlie F, Moretti M (1990) A protocol of managing severe preeclampsia in the second trimester. Am J Obstet Gynecol 163:733–738

    CAS  PubMed  Google Scholar 

  29. Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA (1993) Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes and low platelets (HELLP-syndrome). Am J Obstet Gynecol 169:1000–1006

    CAS  PubMed  Google Scholar 

  30. Spencer CD, Crane FM, Kumar JR, Alving BM (1982) Treatment of postpartum hemolytic uremic syndrome with plasma exchange. JAMA 247:2080–2089

    Article  Google Scholar 

  31. Stahnke E (1922) Über das Verhalten der Blutplättchen bei Eklampsie. Zentralbl Gynakol 46:391–392

    Google Scholar 

  32. Van Dam PA, Renier M, Blaeklandt M, Buytaert P, Uyttenbroeck F (1989) Dissiminated intravascular coagulation and the syndrome of hemolysis, elevated liver enzymes and low platelets in severe preeclampsia. Obstet Gynecol 73:97–102

    PubMed  Google Scholar 

  33. Volz J, Volz E, Keckstein J (1992) Spontanruptur der Leber bei HELLP-Syndrom. Gebhilfe Frauenheilkd 52:152–156

    CAS  Google Scholar 

  34. Weinstein L (1982) Syndrome of hemolysis, elevated liver enzymes and low platelet count: A severe consequence of hypertension in pregnancy. Am J Obstet Gyncecol 142:159–168

    CAS  Google Scholar 

  35. Welsch H, Krone HA (1994) Mütterliche Mortalität bei HELLP-Syndrom in Bayern 1983–1992. Zentralbl Gynakol 16:202–206

    Google Scholar 

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  1. Universitäts-Frauenklinik, Schanzeneckstrasse 1, CH-3012, Bern, Switzerland

    H. Schneider

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Schneider, H. Leberpathologie im rahmen des HELLP-syndroms. Arch Gynecol Obstet 255 (Suppl 2), S245–S254 (1994). https://doi.org/10.1007/BF02389238

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  • DOI: https://doi.org/10.1007/BF02389238

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