Hemolysis, Elevated Liver Enzymes, And Low Platelets Research Articles

Effects of endometriosis on pregnancy outcomes in Fujian province.

Endometriosis is a common gynecological disease, affecting 5 to 10% of women of childbearing age. We analyzed pregnancy complications and neonatal outcomes of patients with pregnancies complicated with endometriosis. The aim of the study was to explore the effects of endometriosis on pregnancy and to evaluate the potential pregnancy risks associated with this disease. The retrospective study included 3,809 parturients who were routinely examined, hospitalized and underwent cesarean section delivery in Fujian Maternal and Child Health Hospital from January 2014 to December 2020. Among them, 1,026 parturients were diagnosed with endometriosis after the cesarean section (endometriosis group), and 2,783 parturients without endometriosis comprised the control group. The endometriosis group was further divided into subgroups according to the severity of the disease: 882 parturients with stage Ⅰ or Ⅱ of endometriosis, and 144 parturients with stage Ⅲ or Ⅳ of endometriosis. General data of all patients and medical records of pregnancy complications and neonatal outcomes for each group were collected and retrospectively analyzed. There were no statistically significant differences in the age, gestational age, gestation, and parity times between all groups (p>0.05). The incidence of preeclampsia and placenta previa in the endometriosis group was higher than that in the control group (p<0.05). There was no significant difference in rates of other pregnancy complications, such as chronic hypertension with pregnancy, preeclampsia with chronic hypertension, hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, gestational diabetes mellitus (GDM), pregestational diabetes mellitus (PGDM), intrahepatic cholestasis of pregnancy (ICP), premature rupture of membranes or placental abruption between the two groups. The incidence of placenta previa in the group of patients with stage III/IV endometriosis was higher than in patients with stage I/II endometriosis (p<0.05). However, there was no significant difference in the incidence of other pregnancy complications. The amount of postpartum hemorrhage (1,000-1,500 ml) in the endometriosis group was greater than that in the control group, and the difference was statistically significant (p<0.05). However, there was no significant difference in the incidence of postpartum hemorrhage in patients with pregnancies complicated with endometriosis at different stages. In pregnant women, endometriosis is associated with an increased incidence of placenta previa that correlates with the severity of the disease. Pregnant women with endometriosis have higher rates of preeclampsia and postpartum hemorrhage, compared to women without endometriosis.

Obstetrical and neonatal outcomes after single and double gamete donation

Introduction: An increasing number of women and couples need oocyte donation to help achieve pregnancy. Several studies have found a correlation between the use of oocyte donation and adverse obstetrical outcomes such as gestational hypertension and preeclampsia. A possible additive risk in using double donation (oocyte and sperm donation) compared to the use solely of oocyte donation has been suggested but only sparsely investigated. The aim of this study is to investigate the differences in obstetric and neonatal outcomes after double donation compared to oocyte donation.Methods: This is a retrospective cohort study of 197 women, who achieved pregnancy after oocyte donation between 2015 and 2022. The primary outcomes investigated were gestational hypertension and preeclampsia. Secondary outcomes were early pregnancy loss, HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelets) syndrome, fetal growth restriction, and gestational diabetes mellitus.Results: No significant differences between the use of oocyte and double donation were observed, when looking at the risk of developing gestational hypertension (AOR = 1.02, 95%CI = [0.33;3.15], P = 0.97) or preeclampsia (AOR = 2.4, 95%CI = [0.68;8.41], P = 0.17). We observed no significant differences between the two groups regarding any of the secondary outcomes.Conclusion: This study did not find an increased risk of obstetrical or neonatal complications such as preeclampsia, gestational diabetes mellitus, or fetal growth restriction after double donation compared to oocyte donation.

Severe maternal morbidity surveillance, temporal trends and regional variation: A population-based cohort study.

To quantify temporal trends and regional variation in severe maternal morbidity (SMM) in Sweden. Cohort study. Live birth and stillbirth deliveries in Sweden, 1999-2019. Types and subtypes of SMM were identified, based on a standard list (modified for Swedish clinical setting after considering the frequency and validity of each indicator) using diagnoses and procedure codes, among all deliveries at ≥22 weeks of gestation (including complications within 42 days of delivery). Contrasts between regions were quantified using rate ratios (RRs) and 95% confidence intervals (95% CIs). Temporal changes in SMM types and subtypes were described. Types and subtypes of SMM. There were 59 789 SMM cases among 2 212 576 deliveries, corresponding to 270.2 (95% CI 268.1-272.4) per 10 000 deliveries. Composite SMM rates increased from 236.6 per 10 000 deliveries in 1999 to 307.3 per 10 000 deliveries in 2006, before declining to 253.8 per 10 000 deliveries in 2019. Changes in composite SMM corresponded with temporal changes in severe haemorrhage rates, which increased from 94.9 per 10 000 deliveries in 1999 to 169.3 per 10 000 deliveries in 2006, before declining to 111.2 per 10 000 deliveries in 2019. Severe pre-eclampsia, eclampsia and HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome (103.8 per 10 000 deliveries), severe haemorrhage (133.7 per 10 000 deliveries), sepsis, embolism, disseminated intravascular coagulation, shock and severe mental health disorders were the most common SMM types. Rates of embolism, disseminated intravascular coagulation and shock, acute renal failure, cardiac complications, sepsis and assisted ventilation increased, whereas rates of surgical complications, severe uterine rupture and anaesthesia complications declined. The observed spatiotemporal variations in composite SMM and SMM types provide substantive insights and highlight regional priorities for improving maternal health.

Medical Emergencies in the Pregnant Patient.

This review article provides a comprehensive overview of common medical emergencies that can occur in pregnant patients. We summarize the key diagnostic and management steps for each emergency to assist health care professionals in identifying and treating these potentially life-threatening conditions. The medical emergencies discussed in this article include postpartum hemorrhage; hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome; acute fatty liver of pregnancy; amniotic fluid embolism; pulmonary embolism; acute respiratory distress syndrome; and shock. Each condition is described in detail, with a focus on the clinical presentation, diagnostic workup, and treatment options. The information presented in this review article is based on current best practices and guidelines from leading medical organizations. We hope this article will serve as a valuable resource for health care professionals who care for pregnant patients and help improve outcomes for these patients in emergency situations.

Is COVID-19 a Risk Factor for Hypertensive Disorders of Pregnancy?

Objective: This study aims to assess whether COVID-19 infection during pregnancy is a risk factor for hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, and eclampsia. Methods: A retrospective evaluation was conducted on obstetric patients who gave birth between March 2020 and December 2021 at Augusta University Medical Center, an academic urban referral center in Augusta, GA. The patients were categorized into two groups: those who were COVID-19 positive during pregnancy and those who were COVID-19 negative. The primary outcome was the development of a hypertensive disorder of pregnancy. Secondary outcomes included preterm delivery, mode of delivery, maternal death, maternal ICU admission, NICU admission, intrauterine fetal demise/stillbirth, fetal growth restriction, and prolonged hospital stay. The association between COVID-19 status and categorical outcomes was assessed using Chi-squared and Fisher’s exact tests. Mean differences between groups were evaluated using Student’s two-sample tests. Additionally, a multinomial multiple logistic regression was performed to assess whether COVID-19 is a risk factor for hypertensive disorders of pregnancy when adjusting for potential confounding effects. Results: Out of the 2760 charts reviewed, 2426 (87.9%) met the inclusion criteria. Of those 2426 patients, 203 were COVID-positive and 2223 were COVID-negative . There were no significant differences in patient sociodemographic information between the COVID-19 positive and negative groups. After adjusting for potential confounding effects, COVID-19 was determined to be a risk factor for combined hypertensive disorders of pregnancy (OR 1.93, 95% CI 1.39-2.66) and preeclampsia specifically (OR 2.01, 95% CI 1.38-2.88). For the observed secondary outcomes, COVID-19 infection during pregnancy was associated with an increased risk of cesarean delivery (p = 0.046), maternal ICU admission (p = 0.008), and prolonged hospital stay (p &lt; 0.001). Conclusion: The findings of this study suggest that COVID-19 infection during pregnancy is linked to an increased risk of developing preeclampsia. COVID-19 was not a statistically significant risk factor for gestational hypertension when controlling for confounding effects. The study was unable to draw conclusions about more severe hypertensive conditions of pregnancy (HELLP, Eclampsia), likely due to their low prevalence in the study sample. COVID-19 was shown to be a risk factor for cesarean delivery, prolonged hospital stay, and maternal ICU admission in secondary outcome analysis. This research contributes to existing knowledge by examining the association between COVID-19 and hypertensive disorders of pregnancy during a period encompassing multiple strains of the COVID-19 virus.

Optimizing Delivery Strategies in Eclampsia: A Comprehensive Review on Seizure Management and Birth Methods.

Eclampsia seizure is an always serious and potentially fatal obstetric condition. Safe delivery in women with pregnancies complicated by eclampsia seizures is still one of the greatest challenges in perinatal medicine. Pregnancy should be terminated (childbirth) in the safest and least traumatic way possible. Attempting vaginal delivery can take place only exceptionally, in the event of possibly quick completion of childbirth with a stable state of the mother and the fetus. However, immediate labor via cesarean section is most often recommended. It is essential to maintain left lateral patient positioning during cesarean section. Regional anesthesia can be used only in conscious patients who are free from coagulopathy and from HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome to decrease the risk of aspiration and failed intubation attempts in preeclamptic or eclamptic women. For sudden, unexpected interventions, when a patient arrives at the hospital with an eclampsia seizure without lab results, general anesthesia can be the best option and should be performed by an experienced medical team of anesthesiologists, ready to perform difficult intubation. Magnesium sulfate is the drug that should be used first to stop eclamptic convulsions and prevent their recurrence. Intravenous antihypertensive drugs can stabilize elevated blood pressure (BP), preventing multiorgan failure and recurrent eclampsia seizure, and thus the prevention of maternal death. This article aims to review the management of seizures during pregnancy in women with eclampsia to ensure safe delivery.

Fluid Overload Management in HELLP Syndrome with Pulmonary Edema Underwent Caesarean Section

Introduction: HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is a multisystemic disorder. HELLP syndrome is a life-threatening condition with high maternal and infant mortality rates. This study aimed to present an unexpected case of HELLP syndrome complicated by pulmonary edema. Case presentation: A 40-year-old woman, 80 kg, who was 26-27 weeks into her pregnancy, came to the obstetric department due to fever and nausea in the past three days. She was then referred to the internal medicine department and diagnosed with dengue fever by the symptom of fever and thrombocytopenia. After two days of in-patient treatment, the obstetrician diagnosed her with HELLP syndrome, followed by elevated liver enzymes. She was then posted for an urgent caesarean section, and we managed this case under general anaesthesia. Postoperatively, we aimed for -500 to -1,000 mL cumulative fluid balance to avoid further hypovolemia. Conclusion: The patient showed improvement, as evidenced by chest X-ray and oxygen saturation. Management of fluid overload in this patient with HELLP syndrome was challenging. On the second day in ICU, the antibiotic was changed from meropenem combined with levofloxacin to meropenem combined with amikacin because the leucocyte level increased and procalcitonin level increased in 48-72 hours.

Aspirin Discontinuation at 24 to 28 Weeks’ Gestation in Pregnancies at High Risk of Preterm Preeclampsia: A Randomized Clinical Trial

ABSTRACT Preeclampsia affects up to 4% of pregnancies and is marked by the development of hypertension and proteinuria after 20 weeks of gestation. Complications associated with the disorder include preterm birth, fetal growth restriction, placental abruption, HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, seizures, and other end organ damage. Aspirin has been shown to reduce the incidence of preterm preeclampsia by 62%. However, it can also lead to peripartum bleeding. Screening for preeclampsia in the first trimester (11 to 13 weeks' gestation) can help identify up to 60% of pregnant individuals who will develop preterm preeclampsia. If preeclampsia screening is conducted during this first trimester, aspirin can be initiated earlier and discontinued earlier to mitigate the risk of peripartum bleeding. In addition, increased soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1:PlGF) ratio is associated with preeclampsia weeks before its clinical onset. An sFlt-1:PlGF of ≤38 has been shown to accurately exclude preeclampsia in pregnant individuals with suspected disease. The aim of this study was to compare the effect of discontinuing aspirin in pregnant individuals at 24 and 28 weeks' gestation with a normal sFlt-1:PlGF ratio of ≤38 against those who continued aspirin treatment until 36 weeks of gestation. This was an open-label, randomized, noninferiority trial conducted at 9 maternity hospitals in Spain. Included were adult individuals with singleton pregnancies who had live births, were found to be at high risk of preeclampsia at the first-trimester screening, and a normal sFlt-1:PlGF between 24 and 28 weeks of gestation. Participants were randomly assigned 1:1 to discontinue aspirin (intervention group) or continue aspirin treatment (control group). The primary outcome was delivery due to preterm preeclampsia (before 37 weeks' gestation). Noninferiority was met if the higher 95% confidence interval (CI) for the difference in the incidences of preterm preeclampsia between the 2 groups was &lt;1.9%. A total of 964 pregnant individuals, who were identified as high-risk for preterm preeclampsia and prescribed 150 mg of aspirin daily at bedtime, were eligible for the analysis. The rates of preterm preeclampsia in the intervention and control groups were 1.48% and 1.73%, respectively (absolute difference, −0.25% [95% CI, −1.86% to 1.36%]). In conclusion, the threshold for noninferiority was not met. In pregnant individuals at high risk of preeclampsia and a normal sFlt-1:PlGF ratio of ≤38, discontinuing aspirin at 24 to 28 weeks' gestation was noninferior to continuing aspirin until 36 weeks to prevent preterm preeclampsia.

Decreased Levels of Soluble Developmental Endothelial Locus-1 Are Associated with Thrombotic Microangiopathy in Pregnancy.

HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome is a life-threatening complication of pregnancy, which is often secondary to preeclampsia. To date, there is no biomarker in clinical use for the early stratification of women with preeclampsia who are under increased risk of HELLP syndrome. Herein, we show that the levels of circulating developmental endothelial locus-1 (DEL-1), which is an extracellular immunomodulatory protein, are decreased in patients with HELLP syndrome compared to preeclampsia. DEL-1 levels are also negatively correlated with the circulating levels of kidney injury molecule-1 (KIM-1), which is a biomarker for disorders associated with kidney damage. Receiver-operating characteristic curve analysis for DEL-1 levels and the DEL-1 to KIM-1 ratio demonstrates that these values could be used as a potential biomarker that distinguishes patients with HELLP syndrome and preeclampsia. Finally, we show that placental endothelial cells are a source for DEL-1, and that the expression of this protein in placenta from patients with HELLP syndrome is minimal. Taken together, this study shows that DEL-1 is downregulated in HELLP syndrome both in the circulation and at the affected placental tissue, suggesting a potential role for this protein as a biomarker, which must be further evaluated.

The Role of Pancreatic Stone Protein (PSP) as a Biomarker of Pregnancy-Related Diseases.

Background: Pancreatic stone protein (PSP) is a biochemical serum marker that contains levels that are elevated in various inflammatory and infectious diseases. The role of PSP in the diagnosis of these diseases seems to be more important compared to clinically established biochemical serum markers in discriminating the severity of the same diseases. Standard values for PSP in pregnant women in relation to gestational age have been reported recently. Additionally, increased PSP levels have been observed to be associated with renal dysfunction in pregnant women. The aim of this study is to evaluate the diagnostic role of PSP in pregnancy-related diseases, such as pre-eclampsia (PE), hemolysis-elevated liver enzymes, and low platelet (HELLP) syndrome. In addition, the study aims to assess its diagnostic role in inflammation-triggered diseases as preterm premature rupture of membranes (PPROM) or COVID-19-positive pregnant women. Materials and Methods: In this single-centred prospective study performed at a tertiary university hospital between 2013 and 2021, we included 152 pregnant women who were diagnosed with either PE, HELLP syndrome, or PPROM. In December 2020, in the context of the COVID-19 pandemic, the Independent Ethics Committee (IEC) approved an amendment to the study protocol. Depending on the underlying disease, single or serial-serum PSP measurements were assessed. These PSP values were compared to PSP levels of women with normal pregnancies. Results: Pregnant women diagnosed with pre-eclampsia or HELLP syndrome had significantly increased PSP values (mean 9.8 ng/mL, SD 2.6) compared to healthy singleton pregnant women (mean 7.9 ng/mL, SD 2.6, p ≤ 0.001). There was no difference in serum PSP in pregnant women with PPROM compared to women with uncomplicated singleton pregnancies (mean in PPROM: 7.9 ng/mL; SD 2.9 versus mean in healthy pregnancies: 7.9 ng/mL; SD 2.6, p = 0.98). Furthermore, no difference in the PSP values in women with or without intra-amniotic infection was observed (infection: mean 7.9 ng/mL; SD 2.8 versus no infection: mean 7.8 ng/mL; SD 3, p = 0.85). The mean value of PSP in COVID-19-infected women during pregnancy (8.5 ng/mL, SD 2.3) was comparable to healthy singleton pregnancies (mean 7.9 ng/mL, SD 2.6), p = 0.24. Conclusions: The novel serum biomarker PSP is significantly upregulated in pregnant women with pre-eclampsia and HELLP syndrome. Our observations call for the further evaluation of PSP in randomized controlled clinical trials to demonstrate the actual role of PSP in pregnancy-related diseases and whether it may provide new approaches for the management and discrimination of the severity of these gestational conditions.

Assessing the Impact of the Zero Mother Mortality Preeclampsia Program on Maternal Mortality Rates at a Single Center in Bandung, West Java (2015-2022): A Retrospective Study.

BACKGROUND The Zero Mother Mortality Preeclampsia (ZOOM) program was adopted as an accelerated initiative to curb mortality related to hypertensive disorders in pregnancy, including preeclampsia. This single-center, retrospective study in Bandung, West Java, aims to evaluate the impact of the ZOOM program implemented from 2015 to 2022. MATERIAL AND METHODS We analyzed 19,176 childbirths and associated maternal deaths due to hypertension in pregnancy. Diagnoses were validated using blood pressure measures, lab tests including urine protein, liver function, blood profiles, platelets, X-ray, echocardiography, and COVID-19 testing. The case fatality rate (CFR) was assessed to evaluate the impact of the ZOOM program. RESULTS Hypertension in pregnancy was identified in 25.1% of cases, with 9.8% and 1.4% attributed to preeclampsia and eclampsia, respectively. Maternal deaths associated with hypertension accounted for 36.6%, with the majority linked to eclampsia. Heart failure (45.5%) and Hemolysis, Elevated Liver enzymes, and Low Platelets (HELLP) syndrome (22%) were the most common complications. The CFR decreased from 61% in 2018 to 10% in 2022. The overall CFR from 2015 to 2022 was 1.3%, with the highest fatality rate observed in eclampsia cases (9.4%). However, a declining trend was seen since 2018, reaching a low of 0.2% in 2021. CONCLUSIONS The implementation of the ZOOM program, which includes preeclampsia re-education, early detection, prompt intervention, protocol adjustments, and a refined referral system, led to a marked reduction in maternal deaths from hypertensive pregnancy disorders.

Placental Endocan Expression in Woman With Preeclampsia and its Relation With Maternal and Fetal Outcomes: A Cross-section Study

Objectives: This study aimed to determine placental endocan expression in women with preeclampsia (PE) and its relation to fetal and maternal outcomes. Materials and Methods: This cross-sectional study was carried out at the Obstetrics Department/Al-Yarmouk Teaching Hospital from January 2020 to October 2020. The study included 90 pregnant inpatient women with PE. The participants were divided into 3 groups including 30 patients with severe PE, 30 non-severe PE, and 30 normotensives. After delivery, placental endocan expression was determined immunohistochemically. Results: The study showed that endocan was expressed in 44 patients’ placenta, all of them were hypertensive vs. 46 negatives for endocan (P=0.001), this expression correlated with adverse maternal outcomes including HELLP (haemolysis, elevated liver enzymes, and low platelets count) syndrome (9.1%), Placental abruption (13.6%) and increase rate of CS (63.6%), as well as adverse fetal outcomes (P=0.001). included stillbirth (13.6%), birth weight &lt;2500 g (68.2%), Apgar score in 1 min &lt;7 (63.6%) and in 5 minutes &lt;7 (31.8), admission to neonatal intensive care unit (NICU) (31.8%), and (68.2%) delivered preterm. Conclusions: This study showed a higher expression of endocan in the placenta of women with PE, and it had a positive correlation with adverse maternal and fetal outcomes.

Clinical features and maternal and fetal outcomes in women with Guillain-Barré syndrome in pregnancy.

Guillain-Barre syndrome (GBS) is an acute inflammatory polyradiculoneuropathy rarely observed during pregnancy. In this retrospective study, we analyzed the characteristics of pregnant women with GBS (pGBS) diagnosed in French University Hospitals in the 2002-2022 period and compared them with a reference group of same-age non-pregnant women with GBS (npGBS) identified in the same institutions & timeframe. We identified 16 pGBS cases. Median age was 31years (28-36), and GBS developed in the 1st, 2nd, and 3rd trimester in 31%, 31% and 38% of cases respectively. A previous infection was identified in six cases (37%), GBS was demyelinating in nine cases (56%), and four patients (25%) needed respiratory assistance. Fifteen patients (94%) were treated with intravenous immunoglobulins, and neurological recovery was complete in all cases (100%). Unscheduled caesarean section was needed in five cases (31%), and two fetuses (12.5%) died because of cytomegalovirus (CMV) infection (1 case) and HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome (1 case). In comparison with a reference group of 18 npGBS women with a median age of 30years (27-33), pGBS patients more frequently had CMV infection (31% vs 11%), had a prolonged delay between GBS onset and hospital admission (delay > 7days: 57% vs 12%), more often needed ICU admission (56% vs 33%) and respiratory assistance (25% vs 11%), and more often presented with treatment-related fluctuations (37% vs 0%). This study shows GBS during pregnancy is a severe maternal condition with significant fetal mortality.

An association of renal profile with maternal complications in women with preeclampsia

Background: Preeclampsia is a multisystem disorder characterized by the development of hypertension to the extent of 140/90 mmHg or more with proteinuria after the 20th week in a previously normotensive and nonproteinuric woman. Renal parameters(Blood urea, Serum creatinine, Uric acid, Urinary protein by dipstick) in patients with preeclampsia. if raised above the normal pregnant values, can help establish the severity of preeclampsia and its associated complications and can help in predicting maternal and perinatal outcomes. The aim of the article was to assess the renal profile in preeclampsia and its association with maternal complications. Materials and Methods: This prospective observational study was conducted in a tertiary health center over two years, from October 2020 to October 2022. Informed written consent had been obtained from women as per the inclusion criteria. With pre-determined proforma, detailed history was obtained. All pregnant women who fulfilled the inclusion criteria after 20 weeks of gestation were included in the study. Apart from routine antenatal investigations in pregnancy, Renal Function Tests (RFTs) were also done in women with preeclampsia. The renal parameters used in the study were Blood urea, Serum creatinine, Serum uric acid, and Urinary protein. The patients with raised renal parameters were followed up repeatedly till delivery. The RFTs were repeated if needed. The maternal outcomes were noted. Results: In the present study, out of 167 women, 67% of preeclampsia patients had no complications, 22% had developed impending eclampsia, 6% had developed hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, and only 3% of the patients had gone into eclampsia. Serum uric acid levels were more than 6.3 in 76% of patients with impending eclampsia, 50% of patients with eclampsia, and 36% of patients with HELLP syndrome.Almost 90% of the patients with HELLPsyndrome had severe proteinuria of urinary protein as 3+, while 73% of impending eclampsia patients had urinary protein 3+. Conclusion: Due to severe impact of preeclampsia on pregnancy outcomes, prompt, and early identification of preeclampsia by using these renal function tests and timely initiation of treatment is essential.

A pregnant woman in her thirties with abdominal pain, seizures and haemorrhagic shock.

A pregnant woman at term was admitted to the emergency department with abdominal pain, generalised seizures and haemorrhagic shock. An outpatient check-up five days earlier showed good general condition, normal blood pressure and normal fetal heartbeat.

First-Trimester Screening for HELLP Syndrome-Prediction Model Based on MicroRNA Biomarkers and Maternal Clinical Characteristics.

We evaluated the potential of cardiovascular-disease-associated microRNAs for early prediction of HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Gene expression profiling of 29 microRNAs was performed on whole peripheral venous blood samples collected between 10 and 13 weeks of gestation using real-time RT-PCR. The retrospective study involved singleton pregnancies of Caucasian descent only diagnosed with HELLP syndrome (n = 14) and 80 normal-term pregnancies. Upregulation of six microRNAs (miR-1-3p, miR-17-5p, miR-143-3p, miR-146a-5p, miR-181a-5p, and miR-499a-5p) was observed in pregnancies destined to develop HELLP syndrome. The combination of all six microRNAs showed a relatively high accuracy for the early identification of pregnancies destined to develop HELLP syndrome (AUC 0.903, p < 0.001, 78.57% sensitivity, 93.75% specificity, cut-off > 0.1622). It revealed 78.57% of HELLP pregnancies at a 10.0% false-positive rate (FPR). The predictive model for HELLP syndrome based on whole peripheral venous blood microRNA biomarkers was further extended to maternal clinical characteristics, most of which were identified as risk factors for the development of HELLP syndrome (maternal age and BMI values at early stages of gestation, the presence of any kind of autoimmune disease, the necessity to undergo an infertility treatment by assisted reproductive technology, a history of HELLP syndrome and/or pre-eclampsia in a previous gestation, and the presence of trombophilic gene mutations). Then, 85.71% of cases were identified at a 10.0% FPR. When another clinical variable (the positivity of the first-trimester screening for pre-eclampsia and/or fetal growth restriction by the Fetal Medicine Foundation algorithm) was implemented in the HELLP prediction model, the predictive power was increased further to 92.86% at a 10.0% FPR. The model based on the combination of selected cardiovascular-disease-associated microRNAs and maternal clinical characteristics has a very high predictive potential for HELLP syndrome and may be implemented in routine first-trimester screening programs.

How to Differentiate Acute Fatty Liver in Pregnancy (AFLP) with Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome in Resource-Limited Settings? - The Importance of Swansea Criteria.

•Both AFLP and HELLP syndrome are accounted as liver diseases in pregnancy.•AFLP and HELLP syndrome should be differentiated to make the proper diagnosis, especially in resource-limited settings.•The correct diagnosis holds a pivotal role since prompt therapy markedly improves the outcome of pregnancy.

MATERNAL AND FETAL OUTCOMES OF JAUNDICE DURING A COMPLICATED PREGNANCY IN TERTIARY CARE HOSPITAL IN KAKINADA DISTRICT: A PROSPECTIVE OBSERVATIONAL STUDY

Background: Viral hepatitis is one of the most common and potentially serious infections that can occur in pregnant women. Liver disease in pregnancy, although rare, can seriously affect the mother and fetus. Physiological changes of a normal pregnancy can be confounding with the sign and symptoms of liver diseases. But it is an essential medical disorder because it has adverse effects on the mother and fetus like PPH, preterm labour, IUD, fetal distress, etc. This study aims to analyze the incidence, demographics, obstetric prole, and causes of jaundice in pregnancy and to know the maternal and fetal outcomes. This is an observational Materials And Methods: study conducted by the Department of Obstetrics and Gynaecology, Governments General Hospital (tertiary care hospital) Kakinada, East Godavari District, Andhra Pradesh. 54 antenatal patients with clinical/laboratory evidence of jaundice were selected for the study between January 2020 to December 2020. Results: The mean (Standard deviation) age of patients was 25.5 ± 5.4. 54 patients had jaundice during pregnancy were analysed. 77% of the patients were between 21 and 35 years old. Most cases were Primi gravida. The incidence of jaundice was 3.7%. The most common cause of jaundice was hemolysis, elevated liver enzymes, and low platelets (HELLP). The most common maternal complication was disseminated intravascular coagulation. The maternal mortality rate was eight. The majority of perinatal outcomes were preterm births. Jaundice in pregnancy has Conclusions: adverse feto-maternal consequences. Improving health awareness, education, regular prenatal examinations, and early referrals lead to early diagnosis and treatment of jaundice during pregnancy, thereby reducing maternal and fetal mortality and morbidity.

Prediction of HELLP Syndrome Severity Using Machine Learning Algorithms-Results from a Retrospective Study.

(1) Background: HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is a rare and life-threatening complication of preeclampsia. The aim of this study was to evaluate and compare the predictive performances of four machine learning-based models for the prediction of HELLP syndrome, and its subtypes according to the Mississippi classification; (2) Methods: This retrospective case-control study evaluated pregnancies that occurred in women who attended a tertiary maternity hospital in Romania between January 2007 and December 2021. The patients' clinical and paraclinical characteristics were included in four machine learning-based models: decision tree (DT), naïve Bayes (NB), k-nearest neighbors (KNN), and random forest (RF), and their predictive performance were assessed; (3) Results: Our results showed that HELLP syndrome was best predicted by RF (accuracy: 89.4%) and NB (accuracy: 86.9%) models, while DT (accuracy: 91%) and KNN (accuracy: 87.1%) models had the highest performance when used to predict class 1 HELLP syndrome. The predictive performance of these models was modest for class 2 and 3 of HELLP syndrome, with accuracies ranging from 65.2% and 83.8%; (4) Conclusions: The machine learning-based models could be useful tools for predicting HELLP syndrome, and its most severe form-class 1.

Role of SOX9 and Hif-1α expression in placentas of patients with HELLP.

In this study, we investigated the immunohistochemical staining of SRY-box transcription factor 9 (SOX9) and Hif-1α expression in placentas of pregnant woman with hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. Placentas of 20 normotensive and 20 women with HELLP syndrome were processed for routine histological tissue processing. The biochemical and clinical parameters of patients were recorded. Placentas were stained with hematoxylin-eosin and SOX9 and Hif-1α immunostaining. Normotensive placentas showed normal histology of placenta, however placentas of HELLP syndrome showed intense thrombosis, thinning of the villi membrane and vascular dilatation. In placentas of normotensive patients, SOX9 reaction was immunohistochemically negative, however placentas of HELLP group showed SOX9 expression in decidual cells, and syncytial regions of floating villi and inflammatory cells. In placentas of normotensive patients, Hif-1α reaction was mainly negative in vessels and connective tissue cells. Placentas of HELLP group showed increased Hif-1α expression in decidual cell and especially inflammatory cells in the maternal region. Hif-1α and SOX9 proteins can be used as a marker to show severity of preeclampsia and regulation of cell proliferation and angiogenesis during placental development.