HELLP-I need somebody.

This narrative traces the development of a relationship between a family physician and a challenging patient who undergoes a cerebro-vascular accident following severe eclampsia. The story describes the patient's complicated relations with her husband, her community, the medical system, and the newborn whom she unconsciously blames for her situation. The slow painful process of developing trust in the therapeutic relationship over nearly 2 decades enables the patient to eventually reflect on herself and consider forgiveness. All identifying information regarding the case was changed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Maternal and fetal outcome of pregnancy complicated by HELLP syndrome.

OBJECTIVE: The study evaluated the maternal and fetal outcome in 64 pregnancies complicated by HELLP syndrome. METHODS: A retrospective analysis of the medical records was performed of patients with HELLP syndrome managed at this tertiary Obstetric unit between January 1996 and December 2005, who were admitted for preeclamsia/eclampsia and had documented evidence of hemolysis, elevated liver enzymes and low platelet count. Maternal and neonatal complications were recorded and analyzed. RESULTS: The incidence of HELLP syndrome in the study was 8.3%. Mean gestational age at delivery was 32.4 +/- 4.2 weeks and mean birth weight was 1851 +/- 810 g. Forty-two percent of the patients had deliveries <32 weeks and 28% IUGR. Respiratory distress syndrome was the main indication for NICU admissions (33.9%). The PNM rate was 20%. Maternal morbidity rate was 34%. The most common maternal complications were abruptio placentae (36.4%) and DIC (31.8%). There was no maternal death. CONCLUSION: Once the diagnosis of HELLP syndrome is confirmed, the management depends on several obstetric and maternal variables like gestational age, severity of laboratory abnormalities and fetal status. As soon as the maternal condition is stabilized and fetal assessment is obtained, prompt delivery of the fetus is indicated. It is not yet established whether expectant management in preterm pregnancies with HELLP syndrome would improve perinatal outcome.

Síndrome Hellp

En la literatura mundial, ha sido descrito un grupo de pacientes obstétricas cuyos hallazgos clínicos: hemólisis, enzimas hepáticas elevadas y recuento plaquetario bajo, conforman una entidad denominada Síndrome Hellp. Esta patología ocurre en un 4 a 12 por ciento de las pacientes preeclámpticas, aunque la preeclampsia puede estar ausente. A continuación se presenta la definición, epidemiología, fisiopatología, enfoque, manejo, resultado materno y neonatal y se destaca la importancia del reconocimiento temprano de las manifestaciones clínicas y de laboratorio para iniciar una terapia enérgica y prevenir la muerte de la madre y del neonato. Además, se describen los parámetros más importantes como indicadores de severidad y recuperación