HELLP Syndrome in Mali

摘要

Background: The authors initiated the present study in Point G Hospital Intensive Care Unit, to evaluate the diagnostic and therapeutic problems of HELLP Syndrome (HS) in Mali.Methodology: It was a prospective study conducted from January 1999 to January 2002 and related to the immediate postpartum period for gravid toxaemia (pre-eclampsia). The traditional triad and the criteria of HS are systematically required in the inclusion criteria. Excluded in the study, were all the toxaemic patients not presenting the triad of this disease. Results: Of 1559 patients hospitalised at the Intensive Care Unit, 9 cases (0.58 %) of HS were recorded for the period of study: 7 multiparas and 2 primiparas. This corresponded to 6.2 % of obstetrical emergencies and 18.0% of gravid toxaemias. The clinical signs were: convulsive crises (eclampsia), high blood pressure, icterus, nausea and vomiting, epigastric with or without hypochondriac pain. The biological signs were anaemia: 6 of 9 cases, obvious low platelet count (between 56,000 and 150,000/mm3) and elevated liver enzymes (2 to 17 times higher than the normal).All the 9 cases of HELLP Syndrome were diagnosed after the delivery. Six foetuses were alive, but hypoxic and 3 died in utero. The maternal complications were eclampsia (7 cases), severe renal insufficiency (6 cases) and disseminated intravascular coagulation (3 cases). In three cases with positive checks for malaria, situation was worsened.In 6 cases of severe anaemia, transfusion was indicated. The most frightening complication was the acute renal insufficiency, but haemodialysis was helpful for 4 of patients (44.4%) after failure of diuretic administration. The evolution was favourable in 6 cases, unfavourable in 3 (33.3 % with maternal deaths). Mortality rate seemed high. The difference of results with Western, Maghrebian and Saudi Arabian practitioners could be explained by the quality of the care available to and especially the delay by our patients in seeking consultation and care in Sub-Saharan Africa. Conclusion: HELLP Syndrome remained a serious complication of pregnancy. It must be suspected for all patients with pre-eclampsia; but also among the pregnant women with normal blood pressure, presenting with digestive symptomatology. The coexistence with serious malaria darkened the maternal prospects in endemic areas. The nature of the disease imposes on caregivers to adopt early multidisciplinary management in obstetrical and neonatal resuscitation units. The decrease in mortality related to HELLP Syndrome, Sub-Saharan countries would require training of practitioners and awareness of the risks, suspicious factors and alarm signs at the antenatal consultations. Introduction According the acronym HELLP, H for haemolysis, EL for elevated liver enzymes and LP for low platelet count, this disease was codified by Weinstein L (9) in 1982. Later, Siba? B M (8) specified its criteria. The traditional triad is the early manifestation of the diffuse visceral attack in worsening pre-eclampsia. Its full treatment comprises the improvement of the visceral perfusion, the control of the blood pressure (BP), the decision and timing of the delivery and its modes. In spite of the high frequency of this Syndrome, it was the subject of very few works in Sub-Saharan Africa. After Iloki LH (6) and Chobli M & Al (2, 3), Diallo A & Al (4) had reported one case each, with successful multidisciplinary management. In view of the scarcity of articles on the subject in Sub-Saharan Africa, the present study was initiated to evaluate the diagnostic and therapeutic problems of this frightening disease in Mali. Patients And Method The study was conducted at Point G Hospital Intensive Care Unit (Service of Reanimation) in Bamako (Mali), from January 1999 to January 2002. The patients came from the Gynaecologic and Obstetrics service of this hospital, the peripheral hospitals and some private clinics. It was a prospective study related to a series of reproduct