• HELLP-синдром: современный взгляд на проблему
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HELLP-синдром: современный взгляд на проблему

HEALTH OF WOMAN. 2019.2(138): 37–41; doi 10.15574/HW.2019.138.37

Жабицкая Л. А.
Национальный медицинский университет им. А.А. Богомольца, г. Киев

В статье представлен комплексный анализ современных данных про тяжелое осложнение беременности – HELLP-синдром. Изложены новые данные о распространенности, факторах риска возникновения данной патологии и патогенеза, описаны клинические симптомы и критерии диагностики. Проведенная систематизация результатов последних исследований позволила сформулировать особенности дифференциальной диагностики HELLP-синдрома с так называемыми имитаторами данной патологии. Согласно последним рекомендациям FIGO и основным клиническим гайдлайнам, приведены основные принципы ведения беременных с HELLP-синдромом. Также выделены рекомендации по переливанию тромбоцитов (с/без других продуктов крови), основанные на количественном показателе тромбоцитов, способе родоразрешения, наличия активного кровотечения и коагулопатии.

Ключевые слова: HELLP-синдром, критерии диагностики, терапия.

СПИСОК ЛИТЕРАТУРЫ

1. Венцківська І.Б., Жабіцька Л.А., Загородня О.С. та ін. (2017). Екстремальні стани в акушерстві та гінекології. К.: РА-ГАРМОНІЯ. 166.

2. 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. https://doi.org/10.1016/j.ejogrb.2012.09.026

3. American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013 Nov;122(5):1122–1131.

4. Baha M Sibai, MD.HELLP syndrome. Sep 2017.

5. Burke SD, Zsengellér ZK, Khankin EV, et al. Soluble fms-like tyrosine kinase 1 promotes angiotensin II sensitivity in preeclampsia. J Clin Invest 2016; 126:2561. https://doi.org/10.1172/JCI83918

6. Chappell LC, Enye S, Seed P, Briley AL, Poston L, Shennan AH. Adverse perinatal outcomes and risk factors for preeclampsia in women with chronic hypertension: a prospective study. Hypertension 2008 Apr;51(4):1002–9. https://doi.org/10.1161/HYPERTENSIONAHA.107.107565

7. Committee on Obstetric Practice. Committee Opinion No. 623: Emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. Obstet Gynecol 2015 Feb;125(2): 521–525. https://doi.org/10.1097/01.AOG.0000460762.59152.d7

8. Errol R Norwitz, MD, PhD, MBAJohn T Repke, MD. Preeclampsia: Management and prognosis. Aug 03, 2017.

9. Estcourt LJ, Ingram C, Doree C, et al. Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia. Cochrane Database Syst Rev 2016; :CD011980. https://doi.org/10.1002/14651858.CD011980.pub2

10. Gordon A, Raynes-Greenow C, Bond D, et al. Sleep position, fetal growth restriction, and late-pregnancy stillbirth: the Sydney stillbirth study. Obstet Gynecol 2015; 125:347. https://doi.org/10.1097/AOG.0000000000000627

11. Gradman AH, Basile JN, Carter BL, Bakris GL, American Society of Hypertension Writing Group. Combination therapy in hypertension. J Am Soc Hypertens 2010 Jan-Feb;4(1):42–50. https://doi.org/10.1016/j.jash.2010.02.005

12. Lowe SA, Bowyer L, Lust K, McMahon LP, Morton MR, North RA, et al. The SOMANZ guideline for the management of hypertensive disorders of pregnancy. Sydney: SOMANZ; 2014. https://doi.org/10.1111/ajo.12253

13. Minakami H, Morikawa M, Yamada T, et al. Differentiation of acute fatty liver of pregnancy from syndrome of hemolysis, elevated liver enzymes and low platelet counts. J Obstet Gynaecol Res 2014; 40:641. https://doi.org/10.1111/jog.12282

14. National Collaborating Centre for Women’s and Children’s Health (UK). CG107: Hypertension in pregnancy: The management of hypertensive disorders during pregnancy. NICE: Guidance 2010 Aug; 2010 Aug.

15. National Institutes of Health. Drugs and Lactation Database (LactMed). 2015; Available at: http://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm. Accessed March 16, 2015.

16. Roberts JM, August PA, Bakris G, Barton JR, Bernstin IM. The American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Hypertension in Pregnancy. Obstetrics & Gynecology 2013;122(5):1122–1131.

17. Seal SL, Ghosh D, Kamilya G, et al. Does route of delivery affect maternal and perinatal outcome in women with eclampsia? A randomized controlled pilot study. Am J Obstet Gynecol 2012; 206:484.e1. https://doi.org/10.1016/j.ajog.2012.04.009

18. The Figo Textbook of Pregnancy Hypertension. An evidence-based guide to monitoring, prevention and management. 2016. 456p.

19. van Dijk M, Thulluru HK, Mulders J, et al. HELLP babies link a novel lincRNA to the trophoblast cell cycle. J Clin Invest 2012; 122:4003. https://doi.org/10.1172/JCI65171

20. World Health Organization. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. Geneva: WHO; 2011.

21. Zeisler H, Llurba E, Chantraine F, et al. Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia. N Engl J Med 2016; 374:13. https://doi.org/10.1056/NEJMoa1414838