ACTIVITIES OF MIDWIFE IN RECOGNITION AND TREATMENT OF PREECLAMPSIA AND HELLP SYNDROME

Preeklampsija i HELLP sindrom poremećaji su nepoznate etiologije, specifični za trudnoću. Središnji znakovi preeklampsije su novonastala hipertenzija i proteinurija, nakon 20. tjedna trudnoće, u prethodno normotenzivnih žena. Sve je češća dijagnoza u razvijenom svijetu, a ostaje visok uzrok majčinskog i fetalnog morbiditeta i mortaliteta u zemljama u razvoju. Odgađanje rađanja dovodi do faktora rizika povezanih s preeklampsijom, uključujući stariju dob trudnice, pretilost i vaskularne bolesti. Liječenje uključuje različite načine ublažavanja simptoma i znakova bolesti, a jedina definitivna terapija preeklampsije koja zaustavlja proces uzrokovan samim poremećajem jest porođaj. HELLP sindrom javlja se najčešće kao komplikacija preeklampsije, a karakterizira ga hemoliza, povišene vrijednosti jetrenih enzima te trombocitopenija. Smrtnost majki zbog komplikacija HELLP sindroma, kao i perinatalni mortalitet, još uvijek su visoki. Od rizičnih čimbenika najčešći su multiparitet, dob majke viša od 25 godina i loš perinatalni ishod u prethodnim trudnoćama. Simptomatologija je raznolika, a među najčešćim simptomima su nespecifični znakovi nalik virozi te bol ili nelagodnost u epigastriju, mučnina, povraćanje i glavobolja. Terapija se danas prilagođava individualno stanju majke i djeteta te procijenjenoj djetetovoj gestacijskoj dobi. Središnju ulogu u perinatalnoj zaštiti ima primalja, kao prvi i najvažniji kontakt s trudnicom. Veliko znanje, educiranost i stručnost primalje te njena osjetljivost na potrebe trudnice, ključne su u kvalitetnoj primaljskoj skrbi rizične trudnoće. Njena velika zadaća je pratiti stanje trudnice i reagirati pravovremeno, ali i s trudnicom stvoriti otvoren i iskren odnos pun povjerenja, educirati je o njenom trenutnom stanju, načinima liječenja i mogućim rizicima. Također, važne su zdravstveno-odgojne upute koje će primalja dati trudnici, a sve u svrhu dobrog maternalnog i fetalnog ishoda trudnoće komplicirane poremećajima preeklampsije i HELLP sindroma.Preeclampsia and HELLP syndrome are disorders with unknown etiology, specific to pregnancy. Main signs of preeclampsia are newly established hypertension and proteinuria, after 20th week of pregnancy, in previously normotensive women. It is more and more often diagnosis in a developed world and remains a major cause of maternal and fetal morbidity and mortality in developing countries. Postponing birth leads to risk factors associated with preeclampsia, including elderly pregnant woman, obesity and vascular disease. Treatment involves various ways of reducing the symptoms and signs of the disease, and the only final therapy for preeclampsia, that stops the process caused by the disorder, is birth. HELLP syndrome usually occurs as a complication of preeclampsia, characterized by hemolysis, elevated liver enzymes and thrombocytopenia. Maternal mortality due to complications of HELLP syndrome, as well as perinatal mortality, are still high. Most common risk factos are multiparity, age of mother over 25 years and poor perinatal outcome in previous pregnancies. Symptomatology is varied, and most common symptoms are unspecific signs like viral infection, pain or discomfort in epigastric area, nausea, vomiting and headache. Nowadays, therapy adjusts the individual status of mother and fetus and the estimated gestational age of fetus. The main role in perinatal care has a midwife, as the first and most important contact with the pregnant woman. The great knowledge, education and expertise of the midwife and her sensitivity for needs of the pregnant woman are key in good midwifery care for risky pregnancies. Her great job is to track the status of pregnant woman and react timely, but also to create an open and honest relationship full of trust with pregnant woman, educate her about her current condition, treatment options and potential risks. Also, important are health-care instructions given by midwife to pregnant woman, and all for the purpose of good maternal and fetal outcome of the pregnancy complicated by preeclampsia and HELLP syndrome