The HELLP syndrome: clinical issues and management. A Review

Background: 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. Methods: Clinical reports and reviews published between 2000 and 2008 were screened using Pub Med and Cochrane databases. Results and conclusion: 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

Eutrophication Scenaria from Reduced Nutrient Loads to the North Sea

The environmental effects of river nutrient loads to the North Sea have been investigated using a numerical biophysical model, NORWECOM, to perform different reduction scenarios. The simulations demonstrate that the river nutrients have a significant contribution on the annual primary production, both in the southern North Sea, in Skagerrak and along the Norwegian west coast. A 50% reduction in the loads of N and P reduces the primary production with 10-30% in the southern North Sea, and 5-10% in Skagerrak and along the Norwegian west coast. Scandinavian rivers only contribute to the 1-2% level in these reductions, thus continental rivers has the major effect on the environment in all downstream areas. However, it should be noted that this reduction, even in the southern North Sea, is less than the natural variability of the production of phytoplankton. A reduction only in the P values, shows that the production regime in the southern North Sea is phosphorous limited, while nitrogen is the limiting nutrient in the northern North Sea. Focusing on the N/P ratio as a possible proxy for eutrophication, a reduction in the N and P loads reduces this ratio by a similar factor, while a reduction in the P loads only, increases it. Based on this it is proposed to use the N/P ratio for eutrophication assessment

Climatic changes in the deep Norwegian coastal waters and Skagerrak 2000-2005 in relation to previous decades

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Environmental status of the Skagerak and North Sea 2000

An environmental status for year 2000 of the North Sea and Skagerrak has been done based on outputs from a biophysicaf model (NORWECOM). The model results suggests that in year 2000 the mean annua1 primary production in the North Sea was the highest in the period 1985-2000, and that the net inflow through the English Channel, due to an extreme strong influx in the fourth quarter, was the highest on an annua1 basis in the period 1955-2000. Also the oxygen levels and sedimentation rates in the North Sea and Skagerrak have been examined, and a eutrophication assessment conclude that, except for the winter values of nitrate, eutrophication is not a big problem in most of the Skagerrak and Kattegat area. Key words : Skagerrak, North Sea, environmental status NORSK SAMMENDRAG: En koblet fysisk, kjemisk og biologisk havmodell (NORWECOM) er brukt for å simulere år 2000 i Nordsjøen og Skagerrak. Resultatene fra denne modelkjøringen er så brukt for å lage en miljøstatus for dette året. I statusen presenteres blant annet verdier for primærproduksjon, oxygen-nivå, sedimenteringsrate og vanntransport inn til Nordsjøen. Til slutt blir det gitt en vurdering av eutrofieringsgraden i Skage- rak og Kattegat basert på referanseverdier foreslått av svenske miljøstyresmakter

The Jutland Current: Nutrients and physical oceanographic conditions in late autumn 1989

Hydrography, currents, nutrients, water transparency, in situ chlorophyll fluorescence and primary production were studied during a cruise with R/V "G.O. Sars" to the west coast of Denmark, Skagerrak and Kattegat from 27. November to 6. December 1989. The Jutland Current (JC) was partly blocked during this period, probably because of an intensified inflow of water from the central and northern North Sea ( Northern Jutland Current, NJC). This suggests that the NJC can exert a substantial dynamic control of the outflow of nutrientrich water from the coastal areas of the southern North Sea

The Jutland Current: Nutrients and physical oceanographic conditions in late autumn 1989

Hydrography, currents, nutrients, water transparency, in situ chlorophyll fluorescence and primary production were studied during a cruise with R/V "G.O. Sars" to the west coast of Denmark, Skagerrak and Kattegat from 27. November to 6. December 1989. The Jutland Current (JC) was partly blocked during this period, probably because of an intensified inflow of water from the central and northern North Sea ( Northern Jutland Current, NJC). This suggests that the NJC can exert a substantial dynamic control of the outflow of nutrientrich water from the coastal areas of the southern North Sea

Temporal and spatial hydrographic variability in the Skagerrak

This report addresses the tempora1 and spatial variability in the hydrography of the Skagerrak by means of statistical investigations including frequency analyses and spatial correlations. The analysis is based on the fixed hydrographic section across the Skagerrak between Torungen (Arendal), Norway and Hirtshals, Denmark, close to a full year of temporally highly resolved hydrographic measurements by moored automatic current meters, placed off the coast from Torungen, and modelled output from the coupled physical-chemical-biological model system NORWECOM. NORSK SAMMENDRAG: Rapporten omhandler variabilitet i hydrografien i Skagerrak. Ved hjelp av statistiske metoder analyseres variasjonsmønstre i rom og tid. Metodene brukt omfatter frekvensanalyse og romlig korrelasjonsanalyse. Analysen tar utgangspunkt i det faste hydrografiske snittet som går på tvers av Skagerrak fra Torungen (Arendal) til Hirtshals, nær et år med tidsmessig godt oppløste strømmålinger fra en fast montert automatisk strømmåler plassert utenfor Torungen og modellresultater fra den fysisk-kjemisk-biologiske modellen NORWECOM

Formering av bananfluer

I dette prosjektet ville vi teste om forskjellige milj&oslash;er har noen effekt p&aring; formeringen til bananfluer? Dette har vi testet ved &aring; sjekke fordoblingstiden til bananfluene i 5 forskjellige milj&oslash;er, som kan varieres med &aring; endre frukt, forskjellig oksygentilf&oslash;rsel, mangel p&aring; mat, og endring i temperatur. Resultatene viser at de forskjellige milj&oslash;ene hadde mindre effekt p&aring; formeringen enn vi hadde trodd og holdt en stort sett jevn fordoblingstid.&nbsp

Modelling the variability of the drift of blue whiting larvae and its possible importance for recruitment

The first 8 months of the drift of blue whiting larvae has been simulated and studied for the 20 year period 1976-1994, using the 3-dimensional numerical model system NORWECOM (the NORWegian ECOlogical Model system). The model particles assumed to represent larvae are released identically in space and time each year according to best "average" knowledge. Large variations in the drift pattems are seen from year to year, but generally much larger amounts of larvae than expected seems to drift southward from the Porcupine Bank area west of Ireland to the Bay of Biscay. Many of these larvae drift into deep water where chances of survival are assumed to be small. Typically larvae hatched on the northem side of the Porcupine Bank drift northwards through the Faeroe-Shetland Channel, and most of these larvae are located on the shelf. Several distribution parameters are selected and compared with ICES time-series of recruitment