Maʻi maʻi HELLP

ʻO ka maʻi HELLP kahi hui o nā ʻōuli i kū i nā wahine hāpai i loaʻa:

• H: hemolisis (ka haki o nā hunaola ʻulaʻula)
• EL: nā enzymes ate kiʻekiʻe
• LP: helu platelet haʻahaʻa

ʻAʻole i loaʻa ke kumu o ka maʻi HELLP. Manaʻo ʻia he ʻano ʻē aʻe o preeclampsia. I kekahi manawa ke kū nei ka maʻi o HELLP ma muli o kahi maʻi maʻi e like me ka maʻi antiphospholipid.

Hana ʻia ka maʻi ʻo HELLP ma kahi o 1 a 2 o 1,000 hāpai keiki. I nā wahine me ka preeclampsia a i ʻole eclampsia, ulu ke ʻano ma 10% a 20% o nā hāpai keiki.

ʻO ka manawa pinepine e hoʻomohala HELLP ma ke kolu o ka trimester o ka hāpai ʻana (ma waena o 26 a 40 mau pule hānau). I kekahi manawa ulu i loko o ka pule ma hope o ka hānau ʻana o ka pēpē.

He nui nā wahine i loaʻa i ke koko kiʻekiʻe a ua ʻike ʻia me ka preeclampsia ma mua o ka hoʻomohala ʻana i ka maʻi HELLP. I kekahi mau hihia, ʻo nā hōʻailona HELLP ka hōʻailona mua o ka preeclampsia. Kuhi hewa ʻia ke ʻano i kekahi manawa e like me:

• Flu a maʻi maʻi viral paha
• Maʻi maʻi gallbladder
• Hepatitis
• Idiopathic thrombositopenic purpura (ITP)
• Lupus flare
• ʻO Thrombotic thrombositopenic purpura

ʻO nā hōʻailona me:

• Ka luhi a ʻano maikaʻi ʻole paha
• Ka paʻa ʻana o ka wai a me ka loaʻa waiwai keu
• ʻEha poʻo
• Nusea a me ka luaʻi e hoʻomau i ka ʻino
• ʻEha ma ka ʻaoʻao ʻākau a ma waena paha o ka ʻōpū
• Hihi maka
• Nosebleed a i ʻole nā ​​kahe koko e kū ʻole maʻalahi (laha ʻole)
• ʻO ka hopu ʻana a i ʻole nā ​​haunaele (rare)

I ka wā o kahi hoʻokolohua kino, ʻike paha ka mea mālama ola:

• ʻO ke aloha o ka ʻōpū, ʻoi aku ma ka ʻaoʻao luna ʻākau
• Ake akea
• Piʻi koko kiʻekiʻe
• ʻO ka pehu i nā wāwae

Hiki ke kiʻekiʻe nā hoʻāʻo ʻana o ka hana ate (nā enzyme ate). E haʻahaʻa paha nā helu platelet. Hōʻike paha kahi CT scan i ke kahe ʻana o ke ake i loko o ke ake. ʻIke ʻia ka protein nui loa i ka mimi.

E hana ʻia nā hoʻāʻo ʻana i ke olakino o ka pēpē. Hoʻokomo ʻia nā hoʻāʻo me ka hoʻokolohua non-stress fetal a me ultrasound, a me nā mea ʻē aʻe.

ʻO ka mālama nui ka hānau ʻana i ka pēpē i ka wā hiki wawe, ʻoiai inā wanaʻao ka pēpē. ʻO nā pilikia me ke ake a me nā pilikia ʻē aʻe o ka maʻi HELLP hiki ke lilo i mea ʻino a hoʻopōʻino i ka makuahine a me ke keiki.

Hoʻokomo paha kāu mea hāʻawi i ka hana ma ka hāʻawi ʻana iā ʻoe i nā lāʻau e hoʻomaka i ka hana, a i ʻole hana i kahi ʻāpana C.

E loaʻa paha iā ʻoe:

• Hoʻopili ke koko inā pilikia nā kahe koko
• ʻO nā lāʻau Corticosteroid e kōkua i nā māmā o ke pēpē e hoʻomohala wikiwiki
• Nā lāʻau e mālama ai i ke koko kiʻekiʻe
• Hoʻopau ka magnesium sulfate e pale i ka hopu ʻana

Maikaʻi pinepine nā hopena inā ʻike mua ʻia ka pilikia. He mea nui loa ka nānā ʻana i nā prenatal maʻamau. Pono ʻoe e hoʻomaopopo koke i kāu mea hāʻawi inā loaʻa nā ʻōuli o kēia ʻano.

Ke mālama ʻole ʻia ke ʻano i ke kakahiaka, a i 1 o 4 mau wahine e hoʻomohala i nā pilikia koʻikoʻi. Me ka ʻole o ka mālama ʻana, make ka hapa liʻiliʻi o nā wahine.

ʻO ka nui o ka make ma waena o nā pēpē i hānau ʻia e nā makuahine me ka maʻi HELLP ma muli o ke kaupaona hānau a me ka ulu ʻana o nā ʻōpū o ka pēpē, ʻo ia hoʻi nā akemāmā. Hānau ʻia nā pēpē he nui loa (hānau ʻia ma mua o 37 mau pule o ka hāpai ʻana).

Hiki paha i ka HELLP maʻi ke hoʻi i 1 mai ka 4 hāpai keiki e hiki mai ana.

Hiki i nā pilikia ma mua a ma hope o ka hānau ʻana o ka pēpē, me:

• Hoʻomaʻamaʻa intravascular coagulation (DIC). ʻO kahi maʻi kāpili e hiki ai i ke kahe nui (hemorrhage).
• Fluid i loko o nā māmā (edema pulmonary)
• Hewa ʻole nā ​​hakuʻala
• ʻO ka hemorrhage o ke ake a me ka holo pono ʻole
• Ka hoʻokaʻawale ʻana i ka placenta mai ka paia uterine (abruption placental)

Ma hope o ka hānau ʻia ʻana o ka pēpē, hele aku ka maʻi HELLP ma ka hapanui o nā hihia.

Inā loaʻa nā ʻōuli o ka maʻi HELLP i ka wā hāpai:

• E ʻike koke i kāu mea hāʻawi.
• Kāhea i ka helu pilikia kūloko (e like me 911).
• E hele i ka lumi pilikia o ka haukapila a i ʻole kahi hana a me ka lawe.

ʻAʻohe ala i ʻike ʻia e pale aku ai i ka maʻi HELLP. Pono nā wahine hāpai a pau e hoʻomaka i ka mālama prenatal a hoʻomau iā ia ma o ka hāpai ʻana. ʻAe kēia i ka mea hāʻawi e ʻike a mālama i nā kūlana e like me ka HELLP syndrome koke.

• Preeclampsia

Esposti SD, Reinus JF. ʻO nā maʻi Gastrointestinal a me nā maʻi hepatic i ka mea maʻi hāpai. I: Feldman M, Friedman LS, Brandt LJ, eds. ʻO Sleisenger a me Fordtran's Gastrointestinal a me ka maʻi Liver: Pathophysiology / Diagnosis / Management. 10 o ka lā. Piladelapia, PA: Elsevier Saunders; 2016: chap 39.

Sibai BM. Preeclampsia a me nā maʻi hypertensive. I: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Nā Obstetrics: Nā Pregnancies Maʻamau a me nā pilikia. ʻEpekema 7 Piladelapia, PA: Elsevier; 2017: chap 31.