Development Of HELLP Syndrome Research Articles

Difficulties in differential diagnosis of preeclampsia and acute surgical pathology

Aim: to determine the prevalence of preeclampsia and HELLP syndrome among patients hospitalized in surgical departments with complaints of pain in the epigastrium, right hypochondrium and/or nausea and vomiting. Material and methods. An analysis was carried out of visits from pregnant women over 20 weeks to the surgical department in 2023 and 42 cases of hospitalization of pregnant patients with suspected acute surgical pathology hospitalized in surgical departments No. 6 and No. 7 of the Samara City Clinical Hospital No. 1 named after. N.I. Pirogov." The following parameters were assessed: age, gestational age, complaints at the time of admission, general blood test data, urine, biochemical blood parameters (ALT, AST, total protein, creatinine, urea, total bilirubin, LDH, amylase, alkaline phosphatase, CRP), the presence of protein in urine, the state of the hemostatic system, the condition of the fetus according to ultrasound, ultrasound, CTG, the presence of obstetric and gynecological pathology and somatic diseases. Results. Patients with acute appendicitis (7 out of 42 pregnant women) were excluded from the study. Of the remaining 35 patients, the diagnosis of severe preeclampsia, HELLP syndrome was made in 3 cases (8.6%), in 2 cases gestational hypertension or protineria (5.7%) - the main group. Cholelithiasis, acute cholecystitis - in 2 cases (5.7%), in other cases the diagnosis of acute pancreatitis was made - 28 patients (80.0%). The work provides a comparison of clinical and laboratory parameters of patients in two groups - with obstetric and surgical pathology. An clinical case of a combination of severe PE with the development of HELLP-syndrome and cholecystitis is also presented. Conclusions. Based on numerous literature data and the results of our work, we can confidently say that the differential diagnosis between obstetric complications such as PE and HELLP syndrome and acute surgical pathology still remains a pressing interdisciplinary problem. Severe forms of PE can take the form of acute pancreatitis, acute cholecystitis, or exacerbation of chronic diseases of the abdominal cavity and retroperitoneal space. According to the results of our observation, this phenomenon occurred in 15% of patients hospitalized in surgical departments.

Factores de riesgo asociados en el desarrollo de Síndrome de Hellp en gestantes atendidas en el Instituto Nacional Materno PerinataL, Lima, 2018-2021.

ABSTRACT Objectives: To determine the risk factors associated with the development of Hellp Syndrome (HS) in pregnant women attended at the Instituto Nacional Materno Perinatal, 2018-2021. Materials and methods: The study is a retrospective cross-sectional analysis using a case-control design. Twenty-five hundred medical records were collected and 196 cases and controls with Hellp syndrome (HS) were selected following eligibility criteria. A data collection form including variables and study dimensions was used. For the analysis, SPSS software was used, applying frequency techniques and Pearson's Chi-square tests to evaluate associations. Results: In cases of Hellp syndrome (HS), higher frequencies were observed in single and cohabiting women, representing 16.8% (p = 0.583); with primary education level in 20.4% (p = 0.195). Regarding age, 12.2% of SH cases were women between 30 and 32 years of age (p = 0.640). A higher proportion of cases were found with a history of arterial hypertension, with 29.1% (OR: 1.230), and in those with malnutrition, with 27.6% (OR: 1.780). There was no significant association with parity, but a higher frequency of cases was observed in nulliparous women, with 17.9% (OR: 1.538), and in pregnant women with a gestational age of 40 weeks, with 6.1%. Conclusions: Malnutrition is the statistically significant risk factor associated with the development of SH.

Prenatal hypertension as the risk of eclampsia, HELLP syndrome, and critical obstetric hemorrhage

Critical bleeding is a common cause of maternal mortality in obstetric patients. However, the non-obstetric factors underlying critical obstetric bleeding remain uncertain. Therefore, this study aimed to clarify the impact of chronic hypertension on obstetric hemorrhage by evaluating a nationwide administrative database in Japan. Women who gave birth between 2018 and 2022 were enrolled. The primary outcome was critical hemorrhage requiring massive red blood cell (RBC) transfusion during childbirth. In total, 354, 299 eligible women were selected from the database. The maternal mortality rate was >1.0% among those who received a massive RBC transfusion (≥4000 cc), and this amount was used as the cutoff of the outcome. Critical hemorrhage was less frequent with elective Caesarean section (CS) compared with vaginal childbirth or emergent CS (odds ratio [OR], 0.38; 95% confidence interval, 0.30–0.47). Multiple logistic regression analysis adjusting for these obstetric risks revealed that a higher maternal age (adjusted OR [aOR] per 1 year, 1.07 [1.05–1.09]); oral medications with prednisolone (aOR, 2.5 [1.4–4.4]), anti-coagulants (aOR, 10 [5.4–19]), and anti-platelets (aOR, 2.9 [1.3–6.4]); and a prenatal history of hypertension (aOR, 2.5 [1.5–4.4]) and hypoproteinemia (aOR, 5.8 [1.7–20]) are the risks underlying critical obstetric hemorrhage. Prenatal history of hypertension was significantly associated with obstetric disseminated intravascular coagulation (OR, 1.9 [1.5–2.4]); Hemolysis, Elevated Liver enzymes, and Low platelet count (HELLP) syndrome (OR, 3.3 [2.7–4.2]); and eclampsia (OR, 6.1 [4.6–8.1]). In conclusion, a maternal prenatal history of hypertension is associated with the development of HELLP syndrome, eclampsia, and resultant critical hemorrhage.The incidence of HELLP syndrome and eclampsia increased more than fivefold in the presence of prenatal hypertension. However, the likelihood of subsequently developing DIC or experiencing critical bleeding did not change by the presence of prenatal hypertension.

He assessment of the perinatal outcomes of the patients who underwent quad screening test

Objective The aim of this study is to assess the correlation between the poor perinatal outcomes and the serum biochemical markers such as maternal serum alpha fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3) and inhibin-A (INH-A) checked during the quad screening test. Methods In this retrospective study, the results of 485 pregnant women who underwent quad screening test in the Outpatient Clinic of Gynecology and Obstetrics of Faculty of Medicine at Erciyes University, Kayseri, Turkey between January 2018 and January 2019 and met the inclusion criteria were analyzed. The primary result of the study was established as the development of poor perinatal outcomes. The poor perinatal outcomes were defined as gestational diabetes (GDM), gestational hypertension (GHT), preeclampsia, intrauterine growth restriction (IUGR), preterm labor, premature rupture of membranes (PRM), oligohydramnios, polyhydramnios, HELLP syndrome, and intrahepatic cholestasis of pregnancy (ICP). Results A total of 485 pregnant women, who met the inclusion criteria, were included in the study. A significant correlation was found between AFP MoM≥2 and GHT, PRM, preterm labor, and the development of IUGR (p=0.017, p=0.033, p=0.037, and p=0.038, respectively). It was seen that the risk increased 5.1 times for GHT, 3.2 times for preterm labor, and 3.8 times for the development of IUGR. There was a significant correlation between hCG MoM≥2 and the risk of GHT development (p=0.024); however, the risk of GHT development increased for 3.8 times above this value. A significant correlation was found between INH-A being MoM≥2 and the development of GHT and HELLP syndrome (p=0.009 and p=0.005, respectively). In these pregnant women, the risk increased 31 times for the development of HELLP syndrome, and 9.4 times for GHT. In the cases with uE3 MoM£0.5, there was a significant correlation for the development of preeclampsia and HELLP syndrome (p=0.033 and p=0.049, respectively). On the other hand, there was no significant correlation between GDM, ICP, polyhydramnios, and oligohydramnios and AFP MoM, beta-hCG MoM, uE3 MoM and INH-A MoM values. Conclusion In our study, we found correlation between poor perinatal outcomes and the changes in AFP, hCG, uE3 and INH-A levels.

Early development of HELLP syndrome: A case report

Early development of HELLP syndrome: A case report

302. Preeclampsia, HELLP-syndrome after kidney transplantation

Preeclampsia (PE) and HELLP -syndrome often complicates pregnancies after maternal kidney transplantation. Moreover, women who become pregnant after renal transplantation are at higher risk of any TMA(thrombotic microangiopathy)-disorders. Objective We aimed to assess frequency of TMA, PE, HELLP –syndrome and negative obstetric outcomes, kidney function decline during the pregnancy. Methods An retrospective single-center cohort study 01/2014– 12/2017: 19 patients with renal allograft, 29 ± 4.35 years old (24–39). Renal function at conception and after delivery, pregnancy outcomes, clinical and laboratory parameters were collected from women who were pregnant after renal transplantation and had transplant and obstetric care. Results 10 of 19(52,6%) have had laboratory signs of TMA during pregnancy –gr.1. All of them had normal levels of calcineurin inhibitor concentration. Symptoms of TMA were wavy, alternating with spontaneous improvement and were not regarded as manifestations of a possible PE in 6 (sFlt-1 were normal). 4 of 19 (21.3%) had full HELLP-syndrome. Without TMA 9/19- gr.2. Only patients with HELLP or PE had elevated sFlt-1/PlGF ratio. There were no ”pure” PE(without signs of partial HELLP). In patients without signs of TMA, the sFlt-1 / PIGF ratio did not exceed the 4.95. Anemia was detected in all patients, but the signs of TMA showed anemia more pronounced. Thrombocytopenia was noted only in patients with signs of TMA. GFR was significantly reduced in all patients with signs of TMA. Conclusion Signs of TMA during pregnancy after kidney transplantation have had every second woman. Pregnancy outcomes were worse in TMA, newborns had lower Apgar scores, growth and birth weights. Pregnancy after kidney transplantation is independent risk factor of the development of HELLP syndrome, rather than ”pure” PE. Patients with TMA demonstrate the most pronounced impairment of kidney function and an unfavorable outcome of pregnancy.

Importance of correctly interpreting magnetic resonance imaging to diagnose posterior reversible encephalopathy syndrome associated with HELLP syndrome: a case report

BackgroundSevere haemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome in pregnancy are possible underlying trigger factors for posterior reversible encephalopathy syndrome (PRES). Magnetic resonance imaging (MRI) shows diffuse signal abnormalities involving the subcortical white matter in the parieto-occipital lobes. Although the diagnosis of RPES was clearly established by the distinctive reversibility of clinical and radiological abnormalities, it is difficult to distinguish from differential diagnosis. Thus, it is important to correctly interpret MRI.Case presentationWe describe a case of HELLP syndrome with PRES. A 38-year-old pregnant woman was admitted to our hospital as an emergency case with a complaint of upper abdominal pain and headache at 29 weeks of pregnancy and the development of HELLP syndrome. An emergency caesarean section was immediately performed. After the operation, the patient received intravenous corticosteroids, and her blood pressure was controlled. Thereafter, she showed an altered mental status. MRI showed hypersignal intense lesions in the cortical and subcortical white matter in the occipital lobes, basal ganglia and callosal splenium in both the fluid-attenuated inversion recovery (FLAIR) sequence and apparent diffusion coefficient (ADC), but these lesions were not recognized in diffusion-weighted imaging (DWI). These images were suggestive of PRES. The patient was kept in the hospital and received the appropriate treatment, after which the patient’s level of consciousness improved and all laboratory tests and imaging examinations returned normal.ConclusionThe MRI findings were useful for the prompt diagnosis of PRES, characterized by hypersignals in FLAIR and ADC, but not in DWI. Additionally, there was an “atypical” MRI appearance of basal ganglial and callosal splenial involvement in this case, which may mistakenly lead clinicians to diagnose other aetiologies than typical PRES. It is considered that vasogenic oedema is the main pathology of PRES according to the MRI image findings. MRI is the gold standard for diagnosing PRES because it can provide information about cerebral involvement earlier than CT; further, it can be a useful tool in the differential diagnosis. This technique facilitated the prompt diagnosis and treatment of the said patient, ultimately resulting in a good outcome.

Maternal bradycardia occurring prior to onset of HELLP syndrome in a woman with pre-eclampsia

A 36-year-old nulliparous woman developed pre-eclampsia at gestational week (GW) 28–6/7. Cardiac status was checked regularly. Heart rate of 93 beats per minute (bpm) with left atrial diameter (LAD) of...

Overrepresentation of BclI polymorphism of the glucocorticoid receptor gene in pregnant women with HELLP syndrome

Background Because the pathological background of preeclampsia and its severe variant, HELLP syndrome (hemolysis, elevated liver enzymes and low platelet counts) appears to involve a pathological maternal-fetal immune adaptation, we examined whether any association could exist between these disorders and polymorphisms of the glucocorticoid receptor (GR) gene. Methods The BclI, N363S, and ER22/23EK polymorphisms of the GR gene were determined in 300 healthy pregnant women, 150 pregnant women with severe preeclampsia including 17 pregnant women with HELLP syndrome. Results There were no significant differences in carrier and allelic frequencies of the N363S and ER22/23EK polymorphisms between healthy pregnant women and those with severe preeclampsia. However, the allelic and carrier frequencies of the BclI polymorphism were significantly higher in women with HELLP syndrome compared to healthy pregnant women ( p = 0.004; Odds ratio, 2.89) and to those with severe preeclampsia ( p = 0.013; Odds ratio, 2.56). Conclusion Our observations suggest that among pregnant women, the BclI polymorphism is associated with the development of HELLP syndrome, but not that of severe preeclampsia. Since preeclampsia and HELLP syndrome develop exclusively in human, it seems particularly interesting that alignment analysis of DNA sequences obtained from databases indicated the absence of the BclI site in 6 animal vertebral species.

Hyperreactio luteinalis could be a risk factor for development of HELLP syndrome: case report

To report a unique case of hyperreactio luteinalis in pregnancy associated with ovarian torsion and subsequent development of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Case report. University medical center. A 34-year-old primigravida woman with ovarian torsion in 13 weeks of pregnancy and subsequent intrauterine growth restriction (IUGR) and HELLP syndrome. Laparoscopic salpingo-oophorectomy due to the ovarian torsion and cesarean section (CS) due to the development of HELLP syndrome. HELLP syndrome. In the first trimester the patient had symptoms of acute abdomen due to the ovarian torsion. Both ovaries were enlarged and multicystic. Hormonal studies confirmed an abnormally elevated level of hCG (192.000 IU/L), mild hyperthireosis, and hyperandrogenemia. Laparoscopic salpingo-oophorectomy was performed. At 30 weeks of pregnancy, IUGR was confirmed sonographically and clinically, and at 33 weeks severe preeclampsia developed. One week later, HELLP syndrome occurred. Emergency CS was preformed, and she delivered a female newborn weighing 1,640 g. Seven days after delivery, blood pressure and hormonal status returned to normal. Hyperreactio luteinalis due to the abnormally high level of hCG in the first trimester could be a consequence of inappropriate trophoblast invasion and an early sign of subsequently developing preeclampsia, eclampsia, and HELLP syndrome.

Vascular endothelial growth factor (VEGF) polymorphisms in HELLP syndrome patients determined by quantitative real-time PCR and melting curve analyses

BackgroundThe vascular endothelial growth factor (VEGF) has a critical role in vasculogenesis and vascular permeability in several diseases including preeclampsia. There are at least 30 single nucleotide polymorphic (SNP) places on this gene. VEGF G+405C, C−2578A and C−460T SNPs are known to be related to VEGF production. VEGF polymorphisms were studied in preeclampsia, but not in HELLP syndrome. Therefore, we decided to determine the allele and genotype frequencies of VEGF G+405C, C−460T and C−2578A SNPs in healthy pregnant women and HELLP syndrome patients. MethodsThe authors introduced a quantitative real-time PCR method for the determination of the three VEGF SNPs. Blood samples were collected from 71 HELLP syndrome patients and 93 healthy controls. DNA was isolated by using silica adsorption method. The SNPs were determined by quantitative real-time PCR and melting curve analysis using LightCycler. ResultsThere were significant differences in the allele and genotype frequencies of VEGF C−460T SNP between the two study groups. The T allele was present in 71.1% in the HELLP group, while in 53.8% in the controls (p=0.0014). The TT genotype occurred significantly more frequently in the HELLP group than in the control group (45.1% vs. 21.5%; p (for genotype frequencies)=0.0011). The TT genotype carriers had an increased risk of HELLP syndrome, which was independent of maternal age and primiparity (adjusted odds ratio (OR)=3.03, 95% confidence interval (CI)=1.51–6.08; p=0.002). Although the VEGF G+405C allele and genotype distributions did not differ significantly between the two groups, the CC genotype carriers were also found to have an increased risk for HELLP syndrome after adjustment for maternal age and primiparity (adjusted OR=3.67, 95% CI=1.05–12.75; p=0.041). The VEGF C−2578A SNP was not associated with HELLP syndrome. ConclusionsThe quantitative real-time PCR combined with melting curve analyses is a fast and reliable method for the determination of VEGF SNPs. We found that the VEGF −460TT and +405CC genotype carriers have an increased risk of HELLP syndrome. As these two SNPs were previously observed to be related to production of the VEGF protein, we suppose that these VEGF polymorphisms – interacting with other genetic and environmental factors – could play a role in the development of HELLP syndrome.

Smoking and the risk of developing hypertensive diseases in pregnancy: what is the effect on HELLP syndrome?

The aim of our study was to investigate the role of smoking in the development of HELLP syndrome, pre-eclampsia and gestational hypertension. A self-administered questionnaire was sent to 2,600 women who had contacted the German Pre-eclampsia Self-help Group previously for information on hypertensive disorders in pregnancy and to 1,233 controls. Diagnoses were verified by reviewing medical records and classified according to ISSHP criteria. Student's t-test, Wilcoxon test, Chi-square test, and multiple logistic regressions were used for statistical analysis. After matching age, parity, nationality, and education a total of 905 women with a hypertensive disease in pregnancy and 945 controls were evaluated for the present study. In comparison to the patients, controls smoked significantly more often during their pregnancies (8.5%/18%, p<0.0001). Smoking during pregnancy was associated with a decreased risk of developing hypertensive disorders in pregnancy by 56%. The most prominent effect of smoking was on the risk of developing HELLP syndrome (OR 0.19, 95% CI 0.08-0.43) followed by HELLP syndrome + pre-eclampsia (OR 0.33, 95% CI 0.17-0.63), pre-eclampsia only (OR 0.46, 95% CI 0.26-0.8), and gestational hypertension (OR 0.66, 95% CI 0.41-1.08). Smoking is associated with an 80% reduction of the risk developing HELLP syndrome. However, pregnant women should be advised to quit smoking. Understanding the different effects of smoking in the etiology of each subtype of hypertensive diseases in pregnancy will improve the knowledge of underlying pathophysiological mechanisms and may help in designing more effective prevention and treatment strategies.

BMI: new aspects of a classical risk factor for hypertensive disorders in pregnancy

HDP (hypertensive diseases in pregnancy) are one of the leading causes of maternal and fetal mortality and morbidity. BMI (body mass index) is an established risk factor for pre-eclampsia, but its role in HELLP syndrome is unknown. We therefore investigated BMI as a risk factor in the development of HELLP syndrome. At the beginning of pregnancy, BMI was measured in 1067 women with a history of HDP and 1063 controls. Diagnoses of HDP were classified according to ISSHP (International Society for the Study of Hypertension in Pregnancy) and BMI according to WHO (World Health Organization) criteria. After verification of exclusion criteria and matching for confounders, 687 women with hypertensive diseases in pregnancy and 601 controls remained for statistical evaluation by chi(2) test and multiple logistic regressions. As a continuous variable, the increase in BMI was associated with an increase in the development of gestational hypertension {OR (odds ratio), 1.1 [95% CI (confidence interval) 1.062-1.197]} and pre-eclampsia [OR, 1.1 (95% CI, 1.055-1.144)]}, but not for HELLP syndrome. According to WHO definitions, overweight women (BMI > or =25 and <30 kg/m(2)) had a 2-fold (95% CI, 1.365-2.983) risk and obese women (BMI > or =30 kg/m(2)) had a 3.2-fold (95% CI, 1.7-5.909) risk of developing pre-eclampsia when compared with women of normal weight (BMI > or =15.5 and <25 kg/m(2)). Being overweight or having obesity had no effect on the risk of HELLP syndrome. As an increased BMI is correlated with the risk of developing pre-eclampsia but not HELLP syndrome, both diseases have a different risk profile. This finding supports that underlying physiological mechanisms in pre-eclampsia vary from those in HELLP syndrome.

Results of the Pregnancies with HELLP Syndrome

In this study, clinical features, developing complications, and results of thirty-six patients, which were followed up in our Obstetrics and Gynecology and Nephrology departments between 1997 and 2001, with the diagnosis of HELLP syndrome were searched retrospectively. The mean age of the cases followed up with diagnosis of HELLP syndrome were 30.2 ± 5.9 (17–46) years. HELLP syndrome was diagnosed on average in the 32.6 ± 4.8th (23–41) week of gestations. Seventy percent of the cases were with severe preeclampsia and 30% of the cases were with mild preeclampsia. Eleven cases (30%) were nullipara and twenty-five cases (70%) multipara. The average of arterial systolic blood pressure of the cases were 161.6 ± 26 mmHg, and that of diastolic blood pressure was 98.5 ± 16.8 mmHg. In thirteen cases (36%) acute renal failure (ARF), six cases (17%) placenta detachment, two cases disseminate intravascular coagulation (DIC), one case Adult Respiratory Distress Syndrome (ARDS) were developed. In seven cases (19%) intrauterine dead fetuses were detected. In twenty-three cases by cesarian section (64%), in thirteen cases by induction (36%) the pregnancies were terminated in 72 h after diagnosing HELLP syndrome. Birth weights of eleven babies (30%) were below 1500 g. Five of the eleven babies were dead in the neonatal period. Six of the thirteen patients who had ARF were given hemodialysis. Two patients died because of the development of ARF + DIC and ARDS. No predicting factors for the development of HELLP syndrome could be detected, but severe preeclampsia. Therefore we think that preeclamptic pregnancies must be followed up very closely and if HELLP syndrome develops, termination of the pregnancy would be proper as soon as possible.

Maternal middle cerebral artery velocity changes in HELLP syndrome versus pre-eclampsia.

Our objective was to determine whether there is a difference in middle cerebral artery blood flow velocity in patients with the syndrome of hemolysis, elevated liver enzymes and low platelet counts (HELLP syndrome) compared to a matched controlled group of patients with pre-eclampsia and without HELLP syndrome. Six pre-eclamptic patients with HELLP syndrome and 12 pre-eclamptic women without HELLP syndrome had maternal middle cerebral artery blood flow velocity assessed antepartum and at 24 and 48 h postpartum. We compared the effect of the development of HELLP syndrome on middle cerebral artery blood flow velocity changes using non-parametric tests. Patients with HELLP syndrome showed no significant differences in diastolic, systolic, mean middle cerebral artery blood flow velocity or pulsatility index in either the antepartum or 24-h and 48-h postpartum phases when compared to non-HELLP pre-eclamptic patients. Our data suggest that there is no difference in the blood flow velocity waveform of the maternal middle cerebral artery between patients with pre-eclampsia and those with HELLP syndrome.

Early development of HELLP syndrome associated with eclampsia:: A case report

The syndrome of haemolysis, elevated liver enzymes and low platelet count during pregnancy (HELLP syndrome) is recognized as a serious, multisystem disease and diagnosed generally after thirtieth week of pregnancy. In this report, a case who developed eclampsia with HELLP syndrome was discussed.

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.

Early Development of HELLP Syndrome: A Case Report

The HELLP syndrome is a severe complication of pregnancy. It usually occurs in the middle of the third trimester. In our case, however, a very early development is reported.