HELLP Sendromlu Hastalarda Postpartum Kortikosteroid Tedavisinin Maternal Hastalığın Stabilizasyonuna Etkisi

Impact of Postpartum Dexamethasone on Postpartum Disease Stabilization in Women with HELLP Syndrome

Ayla SARGIN ORUÇ,Figen TÜRKÇAPAR,Serdar OĞUZ,Necati HANÇERLİOĞULLARI,Ümit BİLGE,Nuri DANIŞMAN,Zekai Tahir Burak WOMENS

Abstract

OBJECTIVE: To investigate the impact of postpartum corticosteroid therapy on maternal disease inwomen with HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome.STUDY DESIGN: Thirty-eight patients diagnosed with HELLP syndrome were randomly assigned totreatment (n= 19) and control (n=19) groups. Patients in the treatment group were administered dexamethasone 8 mg, 4 mg and 2 mg IV twice daily, on the postoperative days 1, 2 and 3 consecutively.The first dose was given immediately postpartum. Mean arterial pressure, platelet count , aspartateaminotransferase (AST), alanine aminotransferase (ALT) levels were determined every 6 hours.Duration of intensive care and urinary output were also investigated.RESULTS: Relative to the control group, the mean arterial pressure became significantly decreased at42 hours in the steroid-treated group (p = 0.0035), the platelet count increased significantly by 24 hours(p<0.05), and AST and ALT decreased significantly by 24 and 18 hours respectively (p=0.02 and p =0.01, respectively). Treatment group had higher mean platelet count for all time intervals and the difference between the groups was significant after the postpartum 42ndhour (p=0.03). CONCLUSION: We observed a rapid resolution of the laboratory and clinical parameters in patients withHELLP syndrome treated with corticosteroids postpartum. We postulate that use of this therapeutic approach could result in reduced overall maternal morbidity and mortality, shorter intensive-care unit stay,with reduced medical care costs.

Özet

AMAÇ: HELLP (hemolysis, elevated liver enzymes and lowplatelets) sendromlu hastalarda postpartum kortikosteroid tedavisinin maternal hastalığın stabilizasyonuna etkisinin araştırılmasıdır.GEREÇ VE YÖNTEM: HELLP sendromu tanısı alan 39 hastatedavi (n=19) ve control gruplarına (n=19) randomize edildi.Tedavi grubundaki hastalara postpartum 1., 2. ve 3. günlerdesırasıyla günde 2 defa IV olmak üzere 8 mg, 4 mg ve 2 mg dexamethasone verildi. İlk doz doğumdan hemen sonra uygulandı. Ortalama arteryel basınç, trombosit sayısı, aspartat aminotransferaz (AST), alanine aminotransferase (ALT) düzeyleri altısaatte bir ölçüldü. Yoğun bakımda kalış süreleri ve idrar çıkışıda takip edildi. BULGULAR: Steroid alan grupta ortalama arter basıncı postpartum 42. saatte kontrol grubuna göre anlamlı düşük düzeylere ulaştı (p=0,0035), trombosit sayısı postpartum 24. saatteanlamlı daha yüksek (p<0,05), AST ve ALT düzeyleri sırasıyla.