RESUMO
INTRODUCTION: The principal causes of morbidity and mortality during pregnancy in Mexico, are preeclampsia/eclampsia, obstetric hemorrhage and puerperium complications; this is, 62 of maternal deaths in last years. HELLP syndrome was observed between 5 to 25 of the mortality in pregnancies of 36 weeks or less. OBJECTIVE: To analyze patients with HELLP syndrome in ICU's (Intensive Care Unit) of a Gynecology and Obstetric Hospital, related to the abnormal hematological, hepatic and renal results with the obstetric case history and the clinical complications. MATERIALS AND METHODS: A transversal study in patients with HELLP syndrome during 1998 and 1999 were carry out. CASE DEFINITION: Peripheral blood with Microangiopathic hemolysis, elevated liver enzymes: AST, ALT over 40 UI/L, even when were LDH lower than 600 UI/L. It was evaluated the hepatic and renal function, platelets count, microangiopathic hemolysis, arterial pressure, seizures, icteric skin color, blindness, visual disturbances, nausea, vomiting and upper quadrant right abdominal pain. In newborn we analyzed gestational age, sex, weight and APGAR. We studied for an association between maternal and biochemical variables with Correlation Pearson Test, and dependence between variables with lineal regression model. RESULTS: 2878 patients with hypertensives disorders in pregnancy (11.64). The 1.15 (n = 33) had HELLP syndrome with specific maternal mortality of 0.4 per 10,000 live birth, perinatal mortality of 1.62 per 10,000 live birth; and renal damage in 84.5. Coefficient beta was higher between number of pregnancies to platelets count (-0.33) and creatinine clearance (-0.401). CONCLUSION: We found an important renal damage, low platelets, elevated liver enzymes in women with two or more pregnancies. Then we propose there are similarities between HELLP syndrome and Systemic Inflammatory Response Syndrome (SIRS) because they could have the same pathophysiology.
Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Adulto , Anemia Hemolítica/epidemiologia , Complicações na Gravidez/epidemiologia , Hepatopatias , Pré-Eclâmpsia , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Trombocitopenia , Aborto Induzido , Anemia Hemolítica/sangue , Anemia Hemolítica/fisiopatologia , Cesárea , Comorbidade , Complicações na Gravidez/sangue , Complicações na Gravidez/fisiopatologia , Estudos Transversais , Suscetibilidade a Doenças , Doenças do Recém-Nascido/epidemiologia , Hipertensão/complicações , Mortalidade Infantil , Testes de Função Renal , Hepatopatias , Testes de Função Hepática , Idade Materna , Mortalidade Materna , México , Paridade , Pré-Eclâmpsia , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Fatores Socioeconômicos , TrombocitopeniaRESUMO
Se estudió el tiempo de estancia en un hospital general en Guadalajara, Jal. México, entre Enero y Junio de 1995. De una muestra aleatoria de 167 pacientes, 72 correspondieron a servicios quirúrgicos y 95 de medicina; el tiempo de estancia se asoció con la edad del paciente, el motivo de hospitalización, características de los médicos y se evaluó el expediente clínico y el proceso de atención. El promedio de edad de los pacientes fue de 52.6 años, sin diferencias por sexo. Los servicios de medicina atendieron el doble de pacientes sin hospitalización programada. La estancia global fue de 6.83 días (pormedio semejante para ambos servicios), pero el 40 por ciento de los pacientes estuvieron menos de 3 días hospitalizados. Hubo relación significativa (p<0.05) entre el tiempo de espera (secuencia establecidad para el diagnóstico o tratamiento) y el diagnóstico del paciente. No hubo diferencias por edad, aunque los pacientes mayores de 70 años tuvieron el mayor porcentaje de estancia prolongada. No hubo relación con la antigüedad laboral ni con los registros médicos