I-HELLP syndrome

I-HELLP syndrome iyiqembu lezimpawu ezenzeka kwabesifazane abakhulelwe abane:

• H: hemolysis (ukuwohloka kwamangqamuzana abomvu egazi)
• EL: ama-enzyme wesibindi aphakanyisiwe
• LP: ukubalwa kweplatelet okuphansi

Imbangela ye-HELLP syndrome ayikatholakali. Kubhekwa njengokuhlukile kwe-preeclampsia. Kwesinye isikhathi ukuba khona kwe-HELLP syndrome kungenxa yesifo esiyisisekelo njenge-antiphospholipid syndrome.

I-HELLP syndrome yenzeka ekukhulelweni okungaba ngu-1 kuye kwezi-2 kwezingu-1 000. Kwabesifazane abane-preeclampsia noma i-eclampsia, lesi sifo sikhula ngo-10% kuya ku-20% wokukhulelwa.

Imvamisa i-HELLP iba ​​phakathi ne-trimester yesithathu yokukhulelwa (phakathi kwamaviki angama-26 kuye kwangama-40 ukukhulelwa). Kwesinye isikhathi kukhula ngesonto ngemuva kokuzalwa kwengane.

Abesifazane abaningi banengcindezi ephezulu yegazi futhi kutholakala ukuthi bane-preeclampsia ngaphambi kokuba babe ne-HELLP syndrome. Kwezinye izimo, izimpawu ze-HELLP ziyisixwayiso sokuqala se-preeclampsia. Isimo kwesinye isikhathi sitholwa ngendlela engafanele njenge:

• Umkhuhlane noma okunye ukugula okunegciwane
• Isifo se-gallbladder
• Isibindi
• Idiopathic thrombocytopenic purpura (ITP)
• I-Lupus flare
• I-thrombotic thrombocytopenic purpura

Izimpawu zifaka:

• Ukukhathala noma ukuzizwa ungaphathekile kahle
• Ukugcinwa kwamanzi kanye nokuzuza ngokweqile kwesisindo
• Ubuhlungu bekhanda
• Isicanucanu nokuhlanza okuqhubeka nokuba kubi kakhulu
• Ubuhlungu engxenyeni engaphezulu kwesokudla noma maphakathi nesisu
• Umbono ofiphele
• Ukopha ngamakhala noma okunye ukuphuma kwegazi okungeke kume kalula (okungajwayelekile)
• Ukudlikizela noma ukudlikizela (okungajwayelekile)

Ngesikhathi sokuhlolwa komzimba, umhlinzeki wezokunakekelwa kwempilo angathola:

• Ubumnene besisu, ikakhulukazi ohlangothini olungakwesokudla olungaphezulu
• Isibindi esandisiwe
• Umfutho wegazi ophezulu
• Ukuvuvukala emilenzeni

Ukuhlolwa kokusebenza kwesibindi (ama-enzyme wesibindi) kungaba phezulu. Ukubalwa kweplatelet kungaba phansi. I-CT scan ingakhombisa ukopha esibindini. Amaprotheni amaningi angatholakala emchameni.

Ukuhlolwa kwempilo yengane kuzokwenziwa. Ukuhlolwa kufaka ukuhlolwa kokungakhathazeki kwe-fetus ne-ultrasound, phakathi kokunye.

Ukwelashwa okuyinhloko ukuletha ingane ngokushesha ngangokunokwenzeka, noma ngabe ingane ingakafiki isikhathi. Izinkinga zesibindi nezinye izinkinga ze-HELLP syndrome zingakhula ngokushesha futhi zibe yingozi kumama nengane.

Umhlinzeki wakho angadonsela abasebenzi ngokukunikeza imithi yokuqala umsebenzi, noma angenza isigaba se-C.

Ungase futhi uthole:

• Ukumpontshelwa igazi uma izinkinga zokopha ziba nzima
• Imithi ye-Corticosteroid yokusiza amaphaphu engane akhule ngokushesha
• Imithi yokwelapha umfutho wegazi ophakeme
• Ukufakwa kwe-Magnesium sulfate ukuvimbela ukuquleka

Imiphumela ivame ukuba mihle uma inkinga isheshe yatholakala. Kubaluleke kakhulu ukuhlolwa njalo ngaphambi kokubeletha. Kufanele futhi wazise umhlinzeki wakho ngokushesha uma unezimpawu zalesi simo.

Uma lesi sifo singelashwa kusenesikhathi, kuze kufike kwabesifazane kwabangu-4 aba nezinkinga ezinkulu. Ngaphandle kokwelashwa, inani elincane labesifazane liyafa.

Izinga lokufa phakathi kwezingane ezizalwa ngomama abane-HELLP syndrome lincike esindweni sokuzalwa kanye nasekukhuleni kwezitho zomntwana, ikakhulukazi amaphaphu. Izingane eziningi zizalwa ngaphambi kwesikhathi (zizalwa ngaphambi kwamasonto angama-37 ekhulelwe).

I-HELLP syndrome ingabuyela ekukhulelweni okungafika koku-1 koku-4 kwesikhathi esizayo.

Kungaba nezinkinga ngaphambi nangemva kokubeletha kwengane, kufaka phakathi:

• Kusatshalaliswe i-coagulation ye-intravascular (DIC). Isifo sokujiya esiholela ekopha ngokweqile (ukopha).
• Uketshezi emaphashini (i-edema yamaphaphu)
• Ukuhluleka kwezinso
• Ukopha kwesibindi nokwehluleka
• Ukwehlukaniswa kwe-placenta odongeni lwesibeletho (ukuphazamiseka kweplacenta)

Ngemuva kokuzalwa kwengane, isifo se-HELLP siyaphela ezimweni eziningi.

Uma izimpawu ze-HELLP syndrome zenzeka ngesikhathi sokukhulelwa:

• Bona umhlinzeki wakho khona manjalo.
• Shayela inombolo yendawo ephuthumayo (njenge-911).
• Fika egumbini lezimo eziphuthumayo esibhedlela noma ophikweni lwabasebenzi nababelethi.

Ayikho indlela eyaziwayo yokuvimbela i-HELLP syndrome. Bonke abesifazane abakhulelwe kufanele baqale ukunakekelwa ngaphambi kokubeletha futhi baqhubeke nokukhulelwa. Lokhu kuvumela umhlinzeki ukuthi athole futhi alaphe izimo ezinjenge-HELLP syndrome zisuka nje.

• Preeclampsia

I-Esposti SD, uReinus JF. Ukuphazamiseka kwamathumbu nesibindi esigulini esikhulelwe. Ku: Feldman M, Friedman LS, Brandt LJ, ama-eds. ISleisenger neFordtran's Gastrointestinal and Liver Disease: IPathophysiology / Diagnosis / Management. Umhlaka 10. IPhiladelphia, PA: Elsevier Saunders; 2016: isahluko 39.

Sibai BM. I-Preeclampsia nokuphazamiseka kwe-hypertensive. Ku: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Ama-Obstetrics: Ukukhulelwa Okujwayelekile Nenkinga. Umhla wesi-7. IPhiladelphia, PA: Elsevier; I-2017: isahluko 31.