HELLP SYNDROME - TheHELLP T heHELLP Syndrome ATherapeutic...

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The HELLP  The HELLP  Syndrome–  Syndrome–  A Therapeutic  A Therapeutic  Challenge Challenge JOHN ESSIEN M.D. JOHN ESSIEN M.D. JESSICA BARDALES MITAC M.D. JESSICA BARDALES MITAC M.D. J.M RODRÍGUEZ FERNÁNDEZ  J.M RODRÍGUEZ FERNÁNDEZ  M.D. M.D.     EMILIO ORTEGA CALLAVA  M.D. EMILIO ORTEGA CALLAVA  M.D. HOSPITAL GINECOBSTÉTRICO PROVIN CIAL
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Pre-eclampsia -  Is a multisystemic,  idiopathic disorder specific to the  pregnancy and puerperium of the human  species. It is characterized by the clinical  triad of: Hypertension Proteinuria Edema
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Literature dating from  the XIXth  century report:   Very unusual varieties of severe pre-eclampsia  with complicated progress.  These unusual descriptions of pre-eclampsia  are recognised today as the HELLP Syndrome.   Today:  HELLP Syndrome is considered to be an  association of characteristic hepatic and  hematologic disorders.
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WEINSTEIN WEINSTEIN ( 1982 ) H H HEMOLYSIS EL EL ELEVATED LIVER ENZYMES LP LP LOW PLATELETS HELLP HELLP
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The reported incidence 2 a 12 %. Elevated perinatal morbidity and mortality. Maternal Mortality 35 %.
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HELLP S HELLP S Y Y NDROME NDROME : POSIBLE : POSIBLE PATHOPHYSIOLOGY PATHOPHYSIOLOGY CAUSAL AGENTES : Increase in volume., Fetal presence / decidual cell?, Vasospasm?, Deficiente vascular repair?, Idiopathic? Vasculo-endothelial Disorder Platelet Agregation/Consumption Fibrin Activation/Consumption Selective organic Isquemia/nsuficiency Variable Manifestations
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ERITHROCYTIC MORPHOLOGY PLATELET   DISORDERS RENAL   COMPROMISE HEPATIC   DISORDERS IMMUNOLOGIC DISORDERS GENETIC   DISORDERS     Other Factors to consider Other Factors to consider :
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The Causal Factors induce :  Thrombocytopenia  Microangiopathic Hemolytic Anemia Periportal necrosis and distension of  the liver´s Glisson´s capsule.    
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DIAGNOSIS DIAGNOSIS MID-II TRIMESTRE FIRST DAYS POSTPARTUM Antepartum diagnosis is made in  Antepartum diagnosis is made in  70% between 27 and 37 weeks of  70% between 27 and 37 weeks of  gestation. gestation.
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Criteria for establishing the diagnosis of  the HELLP Syndrome Hemolysis Abnormal   peripherical blood smear  Elevated Bilirubin >1.2 mg/dl Elevated liver enzymes S GOT >72 UI / L LDH >600 UI / L Low Platelets Platelet Count < 100 × 10 3  /mm 3   
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: Excessive body weight increase .  Pulse pressure amplification. Systole  pressure  >  140  mmHg,  but  diastole pressure < 90 mmHg. Ophthalmic disorders 
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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HELLP SYNDROME - TheHELLP T heHELLP Syndrome ATherapeutic...

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