The 2015 Compendium for HELLP Syndrome: From Bench to Bedside

James N. Martin, Jr., MD (Editor)
The University of Mississippi Medical Center (UMMC), Jackson, MS, USA

Series: Obstetrics and Gynecology Advances
BISAC: MED033000

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Practitioners of obstetrics, maternal-fetal medicine and consultants in other branches of medicine who help provide excellent care to pregnant patients with hypertensive complications of pregnancy will welcome this compendium about HELLP Syndrome. Drawing upon the expertise of 37 contributors from 15 institutions and four countries, this book summarizes the state of the science and practice for patients with HELLP syndrome. On a global basis, what we call HELLP syndrome accounts for hundreds to thousands of maternal deaths and is responsible for many more thousands of patients that suffer “near miss” mortality, which we more properly term “severe maternal morbidity”.

Our understanding of this pregnancy scourge — the basic science or bench aspects — is still relatively inadequate to fully comprehend the pathogenesis and the pathophysiology of this condition as it relates to its close relative, the syndromic disorder of preeclampsia. Although a corticosteroid-based management scheme has shown great promise in practice and has a strong physiologic basis, there remains a need for a high quality, large-scale (1000+ patients) constructed, prospective placebo-controlled clinical trial involving a heterogeneous patient population to fully and objectively evaluate this approach to practice. The need and the urgency are great given the risk of HELLP to mothers and babies.

What we do know is detailed extensively in the pages within. Contained within the compendium is a current summation of our knowledge about the following aspects of HELLP syndrome:
•How do HELLP and preeclampsia share similarities or demonstrate differences
•The latest on clinical and laboratory diagnoses of HELLP syndrome, including cutting edge research
•Classes and categories of HELLP are clarified for full implementation into practice
•Core concepts and components of recommended management
•A critical look at the current controversy over corticosteroids as a core component of care for patients with HELLP syndrome and the reasons why the jury is still out
•How HELLP impacts maternal morbidity and mortality
•In-depth looks at each of the organ systems impacted by HELLP including the mother’s brain, heart/lungs, the liver and the kidney
•Help with distinguishing HELLP from imitators
•Review of the concepts of rescue with therapeutic plasma exchange when other disorders complicate and confuse patient presentation and care
•Guidance with anesthesia issues of HELLP patient management and potential pitfalls
•Perinatal and neonatal aspects of HELLP
•Risk factors, epidemiology, and recurrence issues
•The infrequently explored areas of HELLP impact on immediate and remote maternal physical and emotional health

Welcome to this extensive and detailed compendium of helpful HELLP syndrome information for practitioners, researchers, patients and all those interested in pregnancy and conditions which threaten its successful outcome.
(Imprint: Nova Biomedical)

Preface

1. The Story Behind the Naming of HELLP Syndrome
(Louis Weinstein, Past Bowers Professor and Chair, Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, PA, USA)

2. The Pathogenesis of HELLP Syndrome: Similarities and Differences with Preeclampsia
(Babbette LaMarca, Associate Professor of Pharmacology & Toxicology, Physiology & Ob/Gyn, Thesis Director, Maternal Fetal Medicine Fellowship Program, The University of Mississippi Medical Center, Jackson, MS, USA)

3. HELLP Syndrome: Clinical & Laboratory Diagnosis
(Nana-Ama E. Ankumah, Baha M. Sibai, University of Texas Health Science Center at Houston, Houston, Texas, USA)

4. Classification & Categorization of HELLP Syndrome
(James N. Martin Jr., Professor of Obstetrics, Gynecology & Maternal-Fetal Medicine, Past Vice Chair & Chief of Maternal-Fetal Medicine (Retired), Department of Obstetrics & Gynecology, The University of Mississippi Medical Center, Jackson, Mississippi, USA)

5. Core Concepts & Components of Best Management for Patients with HELLP Syndrome
(James N. Martin Jr., Professor of Obstetrics, Gynecology & Maternal-Fetal Medicine, Past Vice Chair & Chief of Maternal-Fetal Medicine (Retired), Department of Obstetrics & Gynecology, The University of Mississippi Medical Center, Jackson, Mississippi, USA)

6. HELLP Syndrome: Controversy Over Corticosteroids
(John R. Barton, Director, Maternal-Fetal Medicine, Baptist Health Lexington, Lexington, KY, USA)

7. HELLP Syndrome: Severe Maternal Morbidity
(James N. Martin Jr., Jamil Elfarra, Professor of Obstetrics, Gynecology & Maternal-Fetal Medicine, Past Vice Chair & Chief of Maternal-Fetal Medicine (Retired), Department of Obstetrics & Gynecology, The University of Mississippi Medical Center, Jackson, Mississippi, USA)

8. HELLP Syndrome: Maternal Mortality
(Charlene H. Collier, Ashley M. Johnson, Department of Obstetric and Gynecology, The University of Mississippi Medical Center, Jackson, MS, USA)

9. The Central Nervous System in HELLP Syndrome: Evidence for Impairment
(Kedra Wallace, Marilyn Cipolla, Departments of Obstetrics & Gynecology and Department of Neurobiology and Anatomical Sciences, The University of Mississippi Medical Center, Jackson, MS, USA, and others)

10. Cardiopulmonary Morbidity Complicating HELLP Syndrome
(Marc Parrish, Associate Professor of Obstetrics and Gynecology, Department of Maternal-Fetal Medicine, Kansas University Medical Center, Kansas City, Kansas, USA)

11. HELLP Syndrome & The Liver: Hepatic Pathology, Hemorrhage, Rupture & Failure
(Jamil Elfarra, Marie M. Darby, Richard R. Viscarello, Fellow, Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The University of Mississippi Medical Center, Jackson, Mississippi, USA, and others)

12. The Kidney and Acute Kidney Injury in HELLP Syndrome
(Sarah Novotny, Nicole M. Lee, Department of Obstetrics & Gynecology, The University of Mississippi Medical Center, Jackson, MS, USA)

13. Compounded Complexity: When HELLP Syndrome & Eclampsia Are Concurrent
(Rose Gasnier, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil, Wolfson Medical Center, Holon, Sackler University, Tel Aviv, Israel)

14. When HELLP Might be Something Else: The Differential Diagnosis of HELLP Syndrome
(Rachael Morris, James N. Martin, Jr., Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, The University of Mississippi Medical Center, Jackson, MS, USA)

15. Therapeutic Plasma Exchange Use in Patients with HELLP SYNDROME and HELLP-Like Disorders
(Michelle Y. Owens, Cynthia Bean, Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, The University of Mississippi Medical Center, Jackson, MS, USA)

16. Anesthesia Considerations with HELLP Syndrome
(Arthur Calimaran, Nicole M. Lee, Associate Professor & Vice Chair for Education, Residency Program Director, Chief of Obstetric Anesthesiology, Department of Anesthesiology, The University of Mississippi Medical Center, Jackson, MS, USA, and others)

17. HELLP Syndrome: Anesthesia Considerations when other Diseases Complicate
(Monica del-Rio-Vellosillo, Jose Javier Garcia-Medina, Senior Consultant Anesthetist, Department of Anesthesia, University Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain, and others)

18. Reduced Pseudocholinesterase Activity in Patients with HELLP Syndrome
(Samuel Lurie, Professor, Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel)

19. Perinatal & Neonatal Aspects of HELLP Syndrome
(Carl H. Rose, Associate Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic
Rochester, MN, USA)

20. Infection And Antibiotic Considerations In Patients With HELLP Syndrome
(Ana Martínez Aspas, Mª José Esquembre Gratacós, Department of Obstetrics and Gynecology, Hospital Clínico Universitario de Valencia, Valencia, Spain)

21. HELLP Syndrome: Epidemiology & Recurrence Risk
(Pavan Parikh, Imran Sunesara, Resident in Obstetrics & Gynecology, Department of Obstetrics & Gynecology, The University of Mississippi Medical Center, Jackson, MS, USA, and others)

22. Risk Factors for HELLP Syndrome
(Llanos Belmonte Andujar, María Teresa Gómez García, Ana María Fuentes Rozalén, Carolina Serrano Diana, Esther López del Cerro, Obstetrics and Gynecology Department Hospital of Almansa, Albacete, Spain, and others)

23. Beyond HELLP Syndrome: Prognosis, Recovery & Impact on Future Maternal Health
(Michelle Y. Owens, Eleni Z. Tsigas, Associate Professor, Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, The University of Mississippi Medical Center, Jackson, MS, USA, and others)

24. HELLP Syndrome: The Patient Perspective
(Laney Poye, Melissa Wilson, Eleni Z. Tsigas, Preeclampsia Foundation, Melbourne FL, USA, and others)

Index

“This is a very important contribution to the understanding and clinical approach to a serious, life threatening obstetrical syndrome. James Martin and colleagues have combined basic science with evidence based practice, and a decades long clinical experience, to produce one of the classical and most authoritative publications on the topic. The book is well organized, and should find a place in the library of all obstetrical services.” - Maurice L. Druzin, Stanford University School of Medicine - Obstetrics & Gynecology

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