Complication Of HELLP Syndrome Research Articles

Bilateral Serous Retinal Detachment as a Complication of HELLP Syndrome.

HELLP syndrome is a pregnancy complication, putting at risk the life of mother and child, characterized by high blood pressure, elevated liver enzymes and low platelets. Serous retinal detachment is a rare complication of pregnancy and may be associated with HELLP syndrome. One of the most common symptoms is a decrease in visual acuity. A rare case of bilateral exudative retinal detachment associated with HELLP syndrome is described in a 38-year-old woman a few hours after delivery. Optical coherence tomography (OCT) showed an amount of subretinal fluid and macular edema. Use of systemic corticosteroids and careful management of blood pressure led to early resolution of subretinal fluid and a good recovery of vision. Her final best corrected visual acuity was 1 (decimal notation) in both eyes at 2 weeks after delivery. These types of cases are rarely reported and highlight the importance of increasing awareness of this pathology among ophthalmologists.

Hepatic infarction induced by HELLP syndrome: a case report and review of the literature

BackgroundHELLP syndrome is a rare disease in China, and 20% of patients with severe preeclampsia have been accompanied with HELLP syndrome, which is characterized by the presence of hemolysis, elevated liver enzymes and low platelet count.Case presentationIn this case, we reported that a patient with preeclampsia was diagnosed with HELLP syndrome. Furthermore, hepatic infarction also was found via the computed tomographic (CT) images, which showed peripheral wedge-shaped inhomogeneous low attenuation in the right hepatic lobes via plain CT scan, and the low-density shadow and mottled appearance in the same areas where vessels were seen coursing through them via contrast-enhanced CT scan.ConclusionsBesides typical clinical manifestations of the pregnant patient with preeclampsia, the typical laboratory evidences were elevated liver enzymes and thrombocytopenia. The abdominal CT scan showed imaging features of hepatic infarction, which was helpful to identify the rare complication of HELLP syndrome. Thus, we diagnosed a patient with HELLP syndrome with hepatic infarction, though the patient had no chance to do the liver biopsy.

SÍNDROME HELLP Y RUPTURA DE HEMATOMA SUBCAPSULAR HEPÁTICO: COMUNICACIÓN DE UN CASO

Se presenta un caso de ruptura hepática, en una primigesta de 31 años, quien presentó parto por cesárea por óbito fetal y luego falleció, a pesar de las medidas terapéuticas instauradas. Se hace una revisión de los conocimientos actuales sobre esta complicación del síndrome HELLP.

Hepatic rupture: a rare but serious complication of HELLP syndrome

Hepatic rupture: a rare but serious complication of HELLP syndrome

Reply to: hepatic rupture – a rare but serious complication of HELLP syndrome

Reply to: hepatic rupture – a rare but serious complication of HELLP syndrome

OS018. Maternal mortality and its mainly possible causepre-eclampsia/eclampsia in developing country (Surabaya-Indonesia as themodel)

By slow decrease of Indonesia's 2010 highly maternal mortality rate (MMR) as 228/100,000 births mostly estimated to be out reach toward 2014 MDG target achievement of 118/100,000 births, even maternal deaths are notoriously under reported, possibly at least by as much as quarter. The population of Indonesia according to the 2010 national census is 237.6 million, with 58% living on the island of Java, the world's most populous island since it is only 6% of Indonesia total area. Despite risk approaching strategy and referral method in Indonesia national health system had already been formed but the application has not been optimal yet so that its achievement is still far from destination. To study the correlationship between maternal mortality rate and its mainly possible cause pre-eclampsia/eclampsia Retrospectively study was performed by using data Dr. Soetomo teaching hospital Surabaya and local government of East Java. Before the year 2008 the maternal deaths on our hospital Dr. Soetomo Surabaya was depicted very high as approximate 713/100,000 births (range 5.05-10.24 per 100,000 births) or 105 maternal deaths among 14,712 births. Pre-eclampsia/eclampsia was the most possible cause rate of 50-65%. Although at present tend to be improved situation but the year 2008 classic data indicated bad referral system application of severe pre-eclampsia and eclampsia cases that they came lately into our teaching hospital's intensive care unit with approximately 12.6% major complications consist of 50% lung oedema and the remain with placental abruption and cerebral bleeding. In more detailed description of maternal deaths as 29% died on the day 1 of intensive care unit treatment that some cases were death on arrival, 35% on the day 1-3 and >day 3 showed 36% of deaths. Even 40% our preeclampsia/eclampsia dominated ventilator use in hospital ICU due to >60% lung oedema that almost those 70% persist until 3 days (72h) in respiratory machine use. Our Dr. Soetomo hospital Surabaya as the tertiary hospital and referral center as well we observed 210 cases of severely pre-eclampsia which divided into 40 cases of early onset and late onset type as 170 cases by the year 2010. Mainly the characteristic features in early onset type as follow 70% they were reproductive ages (20-35 years old), 60% was 24-32 gestational weeks, 12.5% got complication of Hellp syndrome, 25% with low albumin serum level (<3g%) and had renal failure as 40%. Despite Indonesia MMR apparently declined over last two decades but it did not slump as expected even it failed to achieve the 2014 MDG's target.

Time Course of Recovery and Complications of HELLP Syndrome with Two Different Treatments: Heparin or Dexamethasone

HELLP syndrome is a severe complication of pregnancy characterized by microangiopathic hemolytic anemia, hepatic dysfunction and thrombocytopenia. Though delivery is the ultimate therapeutic option, medical treatments, including the use of heparin or corticosteroids, have been employed in the attempt to improve maternal prognosis. The aim of this retrospective study was to compare the time course of recovery and the incidence of complications in women with HELLP syndrome receiving either heparin or dexamethasone. Between January 1990 and December 1998, 32 patients with HELLP syndrome were cared for at the Institute of Obstetrics and Gynecology of the University of Florence: 20 patients were treated with heparin, administered subcutaneously at a dose of 5000 IU every 12 h, whereas 12 women received dexamethasone, administered intravenously at a dose of 10 mg every 12 h. Categorical data were evaluated with chi-square and Fisher's exact test; continuous data were analyzed with Mann–Whitney U test; P<.05 was considered significant. In the subgroup treated with heparin the incidence of disseminated intravascular coagulation (DIC) ( P<.02), the number of patients requiring blood transfusion ( P<.05) and the length of stay at the Intensive Care Unit (ICU) ( P<.04) were significantly increased as compared with the subgroup receiving dexamethasone; in this latter subgroup, significantly higher platelet count and hematocrit values, and significantly lower levels of lactate dehydrogenase (LDH) could be documented starting from day 2 after delivery. The results of our investigation suggest that the use of dexamethasone in patients with HELLP syndrome is associated with faster regression and lower incidence of complications in comparison to heparin.

Delivery and HELLP-Syndrom

The laboratory findings of hemolysis, elevated liver enzymes and low platelets are signs of an acute pregnancy complication often associated with abdominal pain and intrauterine growth retardation. A high coincidence with symptoms of preeclampsia is observed. The high rate of complications and the restitution of laboratory findings to normal values following cessation of pregnancy have led to the general recommendation of immediate delivery for about a decade. However, the fact that HELLP syndrome can also occur for up to 1 week post-partum and the results of studies on prolongation of pregnancy call this former concept of management into question, in particular, since there is a high rate of hemostasiological complications after cesarean section in acute HELLP syndrome. Because of the correlation of complications of HELLP syndrome with those of severe preeclampsia, the indication for delivery should be based on the signs of preeclampsia and additional clinical features. The results of studies on prolongation of pregnancies in HELLP syndrome and severe preeclampsia support this concept.

Ethnic variation in the incidence of HELLP syndrome in a hypertensive pregnant population.

To determine whether there is a difference among various ethnic groups in the complication of HELLP syndrome in a hypertensive pregnant population. A cohort of 498 pregnant women were entered into the study and multiple clinical parameters including blood pressure, birthweight percentile, gestational age were abstracted. HELLP syndrome was diagnosed in patients based on thrombocytopenia elevated liver enzymes and hemolysis. Maternal and fetal characteristics including the incidence of HELLP syndrome were compared among various ethnic groups and between the hypertensive categories using analysis of variance. The risk of developing HELLP syndrome was significantly higher in the White and Chinese population compared to the East Indian population (relative risk of 2.2). The development of HELLP syndrome was associated with an increased risk of the development of small for gestational age infants (SGA). The clinical correlates of the HELLP syndrome include ethnic group being highest in Chinese and White populations. A significant risk for the development of small for gestational age infants (SGA) exists in the presence of the HELLP syndrome.

Diabetes insipidus, a rare complication of HELLP syndrome. Report of local experience and review of the literature

Diabetes insipidus, a rare complication of HELLP syndrome. Report of local experience and review of the literature

Liver pathology within the scope of HELLP syndrome

Liver pathology is one of the main features of HELLP syndrome and develops on the basis of a generalised activation of intravascular coagulation. Fibrin deposits and haemorrhagic necrosis predominantly develop in the periportal areas and may eventually lead to subcapsular haematomas or even rupture of the liver. While the compensated form of activation of intravascular coagulation, which is diagnosed by a decrease in antithrombin III and an increase in thrombin-antithrombin III complex (TAT) and the appearance of fibrin, monomers and D-dimers, is found in almost all cases of HELLP syndrome, the decompensated form of intravascular coagulation with prolonged bleeding time (PT, PTT) and drop in fibrinogen is found only in the most severe forms. The development of a decompensation of coagulation correlates with the appearance of severe complications such as liver haematoma, abruptio placentae, renal failure and pulmonary oedema. The best prophylaxis against the development of life-threatening complications is early diagnosis and termination of pregnancy after stabilisation of the maternal condition, consisting of magnesium sulphate infusion, antihypertensive treatment with dihydralazine or calcium antagonists, steroids etc. Severe complications of HELLP syndrome have occasionally been observed in the postpartum period. As prophylaxis against postpartal worsening of HELLP syndrome, curettage of the uterus and continuation of the treatment with calcium antagonists and dexamethasone have been recommended.

Vitreous haemorrhage as a complication of HELLP syndrome.

In the last trimester of an uncomplicated pregnancy a woman developed a spontaneous vitreous haemorrhage. She was later diagnosed as having HELLP syndrome, a recently described disorder comprising haemolytic anaemia, elevated liver enzymes, and a low platelet count in women with severe pre-eclampsia or eclampsia. We believe this rare complication of pregnancy to be the cause of the intraocular bleeding.