The HELLP syndrome: Clinical issues and management. A Review

<p>Abstract</p> <p>Background</p> <p>The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10–20% of cases with severe preeclampsia. The present review highlights occurrence, diagnosis, complications, surveillance, corticosteroid treatment, mode of delivery and risk of recurrence.</p> <p>Methods</p> <p>Clinical reports and reviews published between 2000 and 2008 were screened using Pub Med and Cochrane databases.</p> <p>Results and conclusion</p> <p>About 70% of the cases develop before delivery, the majority between the 27th and 37th gestational weeks; the remainder within 48 hours after delivery. The HELLP syndrome may be complete or incomplete. In the Tennessee Classification System diagnostic criteria for HELLP are haemolysis with increased LDH (> 600 U/L), AST (≥ 70 U/L), and platelets < 100·10⁹/L. The Mississippi Triple-class HELLP System further classifies the disorder by the nadir platelet counts. The syndrome is a progressive condition and serious complications are frequent. Conservative treatment (≥ 48 hours) is controversial but may be considered in selected cases < 34 weeks' gestation. Delivery is indicated if the HELLP syndrome occurs after the 34th gestational week or the foetal and/or maternal conditions deteriorate. Vaginal delivery is preferable. If the cervix is unfavourable, it is reasonable to induce cervical ripening and then labour. In gestational ages between 24 and 34 weeks most authors prefer a single course of corticosteroid therapy for foetal lung maturation, either 2 doses of 12 mg betamethasone 24 hours apart or 6 mg or dexamethasone 12 hours apart before delivery. Standard corticosteroid treatment is, however, of uncertain clinical value in the maternal HELLP syndrome. High-dose treatment and repeated doses should be avoided for fear of long-term adverse effects on the foetal brain. Before 34 weeks' gestation, delivery should be performed if the maternal condition worsens or signs of intrauterine foetal distress occur. Blood pressure should be kept below 155/105 mmHg. Close surveillance of the mother should be continued for at least 48 hours after delivery.</p

The Middle and Late Pleniglacial (Weichselian) malacofauna of the Zemun loess–paleosol sequence, Serbia

The aim of our study was to describe the succession of malacological assemblages along the exposed loess profile located in Belgrade, along the banks of the Danube River (municipality of Zemun). Deposits that belong to the composite loess unit L1 were sampled. Loess unit L1 included two subunits: L1SS1 (a Middle Pleniglacial subunit with two weakly developed initial pedogenic horizons) and L1LL1 (a Late Pleniglacial loess subunit). Three malacological zones were distinguished. Malacological results imply a change in climatic conditions and subsequently in vegetation structure. The molluscs indicate an environment with a moderate (warm and dry) climate and a mosaic vegetation type composed of grasslands and forest steppe. Gradual cooling was inferred within the Late Pleniglacial period. Our findings concur with the results of earlier studies indicating that the Zemun site and the adjacent area served as a transition zone between the refuge areas within the southeastern part of the Carpathian Basin during the Late Pleistocene