Severe HELLP Syndrome Research Articles

Severe preeclampsia and HELLP syndrome requiring plasmapheresis or dialysis: National survey in Japan

Severe preeclampsia and HELLP syndrome requiring plasmapheresis or dialysis: National survey in Japan

Severe preeclampsia and HELLP syndrome at 18 weeks gestation

Severe preeclampsia and HELLP syndrome at 18 weeks gestation

Case report of thrombotic thrombocytopenic purpura during pregnancy with a review of the relevant research.

Thrombotic thrombocytopenic purpura (TTP) is a syndrome characterized by widespread blood vessel clotting and bleeding. It can affect individuals of any age but is more commonly observed in females, particularly during pregnancy. Pregnancy combined with TTP is a critical and rapidly progressing condition that is often misdiagnosed as an obstetric disorder like severe preeclampsia or HELLP syndrome. To deepen the understanding of TTP during pregnancy with the help of a clinical case. A 20-year-old patient, is pregnancy 1 birth 0, 32 weeks dated by her last menstrual period, presented chest tightness, and shortness of breath after physical activity for 3 days. TTP. At present, there are no preventive measures. Timely diagnosis and treatment are useful. Plasma exchange and treat to the patient hinder autoantibodies, such as gamma globulin, methylprednisolone, rituximab, and cyclosporine were effective. The patient exhibited stable vital signs, normal examination results, and experienced no complications. We continued to monitor her progress after she was discharged. The acute onset of TTP is often associated with pregnancy, as it is a triggering factor. Timely identification, accurate diagnosis, and a comprehensive treatment approach involving plasma exchange, immunosuppressants, and the termination of pregnancy can lead to remission and a favorable outlook for the majority of patients.

The relationship between severe hypertensive diseases of pregnancy and moderate-severe bronchopulmonary dysplasia.

Determine the association between severe hypertensive disease of pregnancy (HDP) with moderate-severe bronchopulmonary dysplasia (BPD) in preterm infants (< 31 weeks' gestation). Preterm birth cohort study of 693 mother-infant dyads. Severe HDP was defined as severe preeclampsia, HELLP syndrome or eclampsia. The outcome was moderate-severe BPD classified at 36 weeks corrected gestational age, per the NICHD Consensus statement. 225 (32%) mothers developed severe HDP and 234 (34%) infants had moderate-severe BPD. There was an interaction between severe HDP and gestational age (p = 0.03). Infants born at < 25 weeks gestation to mothers with HDP had increased odds for moderate-severe BPD compared to infants of normotensive mothers delivering at the same gestational age. Infants born > 28 weeks to mothers with severe HDP had decreased odds for the outcome, though not statistically significant. Severe HDP has a differential effect on the development of moderate-severe BPD based on gestational age.

Are NLR, PLR, and Elevated Uric Acid Levels Predictive of Preeclampsia?

Abstract Background It is estimated that 2 to 8% of pregnancies are complicated by gestational hypertension and preeclampsia, the latter being considered a major cardiovascular emergency due to its possible progression to severe eclampsia and HELLP syndrome. New inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), may predict the progression of gestational hypertension. Aim of the study The aim of this study was to assess whether NLR, PLR, and uric acid play a role in predicting preeclampsia and its severe forms. Methods This prospective, single-center cohort study, conducted between January 1, 2020 and December 31, 2022, included 107 pregnant women with gestational hypertension, preeclampsia and its severe forms, HELLP syndrome and eclampsia. Patients were divided into two groups: the first group included 88 patients with gestational hypertension (GH group), and the second group included 19 patients with preeclampsia and its severe forms (PE group). We compared demographic, clinical and biochemistry data between the two groups. Results PLR was significantly lower in women with preeclampsia (85.47 ± 7.91 vs. 115.90 ± 4.63, p = 0.005). The mean serum uric acid level in the PE group was significantly higher than in the GH group (6.71 ± 0.44 mg/dL vs. 4.59 ± 0.12 mg/dL, p &lt;0.0001). Conclusion In this study, low-cost biomarkers PLR and serum uric acid were associated with a higher risk of PE and its severe forms and may be used to predict the progression of gestational hypertension.

Correlation of Neutrophil Lymphocyte Ration (NLR) Values with Severe Preeclampsia, HELLP Syndrome, and Eclampsia

Background: Preeclampsia (PE) is the leading cause of maternal and fetal morbidity and mortality. The disease is characterized by hypertension (≥140/90 mmHg), proteinuria, thrombocytopenia, renal failure, neurological complications, liver involvement, and fetal growth retardation. HELLP syndrome is a variant of preeclampsia that causes an increase in liver enzymes and a low platelet count. Eclampsia is the heaviest complication of preeclampsia. Neutrophil lymphocyte ratio (NLR) is part of the leukocyte type count examination which is an easy, available examination parameter and can be used as an index of the severity of systemic inflammation. This study aimed to determine the relationship of neutrophil-lymphocyte ratio (NLR) values with severe Preeclampsia, HELLP syndrome, and eclampsia.Method: This research is a comparative analytical study with a case control study approach. This research was conducted from April-November 2022. This study was conducted at the emergency room (ER) and inpatient department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Andalas – RSUP Dr. M. Djamil Padang. The study sample was part of the population that met the inclusion and exclusion criteria. The study required 108 samples, namely 27 from the severe preeclampsia group, 27 from the eclampsia group, 27 from the HELLP syndrome group, and 27 from the control group. Bivariate statistical analysis using Independent T-Test. Samples were taken by the method of consecutive sampling. The data were analyzed at a 95% confidence interval, if obtained p value&lt;0.05 then there is a significant relationship. The Data was analyzed by the SPSS computer program.Results: The results of this study obtained neutrophil-lymphocyte ratio in eclampsia has the highest average value compared with HELLP syndrome, severe preeclampsia, and control. While HELLP syndrome has a higher mean value than severe preeclampsia and control and subsequently severe preeclampsia also has a higher mean value NLR than control. This study found a significant relationship between neutrophil-lymphocyte ratio (NLR) with severe Preeclampsia, HELLP syndrome, and eclampsia (all p values=0.000).Conclusion: This study proves that neutrophil-lymphocyte ratio (NLR) has a significant relationship with severe Preeclampsia, HELLP syndrome, and eclampsia so further research can develop this study by analyzing other factors that affect preeclampsia. For clinicians can make this study as a reference in monitoring the progression of inflammation that occurs in severe preeclampsia, HELLP syndrome, and eclampsia.

Serous Retinal Detachment in Pre-Eclampsia: A Systematic Review of Case Report

Serous Retinal Detachment is one of the preeclampsia complications which may be identified during the third trimester of pregnancy or postpartum period that may be related to pregnancy condition. We review case reports related to serous retinal detachment in preeclamptic patients from online databases such as MEDLINE/Pubmed and Science Direct from 2011 to 2021 in accordance with PRISMA guidelines. Authors independently screened abstracts of articles retrieved articles that were considered potentially relevant, and extracted the articles obtained. From 17 articles, serous retinal detachment is higher in severe preeclampsia and HELLP syndrome (88%). Most patients were indicated to do caesarean section (71%) as their mode of delivery due to managing severe preeclampsia. Although most patients (94%) reported retinal detachment involving the macular area, complete resolution was observed in all the patients (94%). Early detection of serous retinal detachment may increase awareness of early detection of severe preeclampsia and HELLP syndrome.

Surgical management of spontaneous hepatic rupture associated with HELLP syndrome. Case presentation and literature review

Background: HELLP syndrome is a serious complication in pregnancy characterized by hemolysis, elevated liver enzymes and low platelet count occurring in 0.2 to 0.6% of all pregnancies and in 10–20% of cases with severe preeclampsia. Spontaneous hepatic capsular rupture is a rare (0,015% of all pregnancies), but a life-threatening complication of HELLP syndrome with a mortality rate of up 50% for both mother and infant. Methods: We present the case of a 34-year-old nulliparous woman with a second trimester gestational hepatic rupture associated with HELLP syndrome. A systematic literature search was conducted on database of PubMed, Scopus, Medline and Embase. Results: Spontaneous hepatic rupture is an infrequent but life-threatening condition of pregnancy associated with severe pre-eclampsia and HELLP syndrome. Diagnosis is based on clinical suspicion. Abdominal CT with intravenous contrast is considered to be the best diagnostic method. The management of this pathology requires a multidisciplinary approach between gynecologists, general surgeons and intensive care physicians. The main therapeutic objectives are: eliminate the causal factor, end the pregnancy and control hemorrhage. If there is not hepatic rupture and the patient is hemodynamically stable, conservative nonoperative management for selected patients has been recommended. However, if the patient presents hemodynamic instability despite adequate resuscitation or hemoperitoneum, it has been seen that surgery significantly reduces the mortality associated with this pathology. Conclusions: Hepatic subcapsular hematoma and hepatic rupture are infrequent but life-threatening complications that can occur during pregnancy and are fundamentally related to pathologies such as preeclampsia and HELLP syndrome. The first step is to end the pregnancy and subsequently control the acute liver problem. Different surgical techniques have been described that should be individualized for each patient according to damage control principles. A high index of suspicion and prompt recognition allows a multidisciplinary approach and mortality can be reduced. Study type: Therapeutic/care management.

Vitreous hemorrhage in a pregnant woman with a history of simultaneous pancreas and kidney transplantation: A case report

Pregnancy after simultaneous pancreas and kidney transplantation (SPKT) carries a high risk of maternal and fetal complications. We report the case of a 39-year-old woman with three consecutive pregnancies with favorable outcomes after SPKT. Within the first year of SPKT, the patient had a spontaneous pregnancy. At 32weeks of gestation, she underwent an emergency cesarean section (CS) due to severe preeclampsia and HELLP syndrome. The infant was of average birth weight and was transferred to the neonatal intensive care unit for further management. A second unplanned pregnancy occurred almost nine months after the first. The antenatal assessments for fetal growth, blood glucose, and blood pressure were normal throughout follow-up. Early in her pregnancy, the patient developed an uneventful retinopathy of the left eye. At 37weeks of gestation, she underwent an elective CS due to a short inter-pregnancy interval and delivered a healthy baby with an average birth weight. At the age of 39years, the patient had a third unplanned pregnancy. She was diagnosed with seronegative antiphospholipid syndrome. She suffered from bilateral vitreous hemorrhage and was managed successfully with a minimally invasive laser treatment combined with an intravitreal injection of anti-vascular endothelial growth factor during her third trimester. At 35weeks of gestation, the patient presented with labor pain and underwent an emergency CS and delivered a healthy baby with an average birth weight. Pregnancy after SPKT requires a multidisciplinary approach with a careful workup.

HELLP syndrome, intracerebral hemorrhage, and hemophagocytic syndrome after cesarean section in a pregnant patient with severe preeclampsia: a case report

BackgroundPregnancy-related intracranial hemorrhage (ICH) is a rare but potentially life-threatening event with complex and varied cause, such as HELLP syndrome and hemophagocytic syndrome.Case presentationA 33-year-old patient underwent a cesarean section with a preliminary diagnosis of "severe preeclampsia and class3 HELLP syndrome ". The patient had poor response to language before surgery, and the catheter drainage fluid was hematuria. Later, the surgeon reported severe bleeding in the operation. Following thromboelastography (TEG) result and postoperative laboratory tests confirmed class1 HELLP syndrome and ICH occurred on the second day after the surgery, and hemophagocytic syndrome was diagnosed during subsequent treatments.ConclusionFor patients with HELLP syndrome, we should pay attention to their coagulation condition. The coagulation tests and platelet counts should be repeated if their clinical presentation changed. Those with neurological alarm signs should receive CT or MRI scan. If a pregnant woman had prolonged hemocytopenia and thrombocytopenia, not only the HELLP but also the hemophagocytic syndrome should be considered.

Therapeutic plasma exchange in postpartum HELLP syndrome: a case report

BackgroundPostpartum hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is more difficult to treat than HELLP syndrome during pregnancy. We describe a case of postpartum HELLP syndrome that responded to plasma exchange (PE) therapy.Case presentationA 30-year-old primipara woman was hospitalized for gestational hypertension at 33 weeks of gestation and underwent an emergent cesarean section at 36 weeks and 6 days of gestation due to rapidly progressing pulmonary edema. After delivery, liver dysfunction and a rapid decrease in platelet count were observed, and the patient was diagnosed with severe HELLP syndrome. She experienced multiple organ failure despite intensive care, and PE therapy was initiated. Her general condition dramatically stabilized within a few hours of PE therapy.ConclusionIt is controversial whether PE therapy should be used primarily in the management of HELLP syndrome, but early initiation of PE therapy could be effective for severe HELLP syndrome.

Роль комплексной эхографии печени в ранней диагностике преэклампсии и HELLP-синдрома

Objective. To study the possibilities of comprehensive ultrasound imaging with pulsed wave mode and Doppler color flow mapping in evaluation of hepatic blood flow and its compensatory capabilities in pre-eclampsia (PE) of different severity. Patients and methods. Complex liver ultrasonography combined with Doppler assessment of arterial and venous blood flow was performed in 87 pregnant women at 28–40 weeks’ gestation. The study group comprised 59 women with PE of varying severity and 12 women with HELLP syndrome. The control group included 30 women with normal pregnancy. Results. Doppler assessment of blood flow in the hepatic artery and in the maternal-placental-fetal system arteries in patients with moderate and severe PE revealed similar changes, which were manifested by elevated vascular resistance in these vessels and correlated with the severity of PE. The maximum values of pulsatility index and resistance index in the hepatic artery were observed in patients with HELLP syndrome – 1.6 ± 0.11 and 0.74 ± 0.08, respectively. Qualitative and quantitative characteristics of blood flow in the portal vein in patients with moderate PE did not statistically differ from those in the control group, while patients with severe PE and HELLP syndrome showed statistically significant disturbances of portal vein blood flow manifested by an increase in portal vein diameter and a decrease in maximum linear velocity of blood flow in the portal vein. Changes in hepatic arterial blood flow were found in patients with moderate PE in the absence of clinical and laboratory manifestations of liver dysfunction. Already in the early stages of PE, a shift of hemodynamic indices toward an increase in peripheral vascular resistance was determined. The increase in hepatic artery vascular resistance was observed in parallel with the increase of similar indices in the uterine-placental-fetal blood flow. Disturbance of blood flow in the portal vein was determined only in patients with severe PE and HELLP syndrome. Conclusion. Vascular disorders of the liver can serve as an additional diagnostic method for early diagnosis of liver involvement in the pathological process, while the signs of portal vein blood flow disorders are a criterion of extremely severe PE course, prognostically unfavorable regarding HELLP syndrome development. Key words: resistance index, liver dysfunction, hepatic artery, pre-eclampsia, hepatic blood flow, pulsatility index, HELLP syndrome

Predictive and diagnostic value of serum sVEGFR-1 level in women with preeclampsia: A prospective controlled study.

Pre-eclampsia (PE), a pregnancy-specific syndrome consisting of hypertension and proteinuria occurring de novo after the 20th week of gestation, remains the leading cause of maternal and fetal morbidity and mortality worldwide. Endothelial dysfunction is proposed to be a central feature of the pathophysiology of preeclampsia. However, the mechanism by which this endothelial dysfunction occurs remains uncertain. We investigated the predictive and diagnostic value of serum soluble vascular endothelial growth factor receptor-1 (VEGFR-1) with by comparison of its prepartum and postpartum serum levels in the management of women with PE. This prospective case-controlled study was composed of pre-eclamptic (n=44) and normal, healthy pregnant (n=44) women. Blood samples were collected before any intervention at the first antenatal examination of the women in the control group and at the admission of the women to the hospital in the PE group, additionally, from all women in the study groups within six hours of the postpartum period, and used for the serum VEGFR-1 analyses. Within both groups, prepartum serum levels of sVEGFR-1 were higher than postpartum levels (p<0.05). In PE, pre-partum and postpartum serum levels of sVEGFR-1 were higher than levels in the control group (p<0.05). Serum sVEGFR-1 levels of preeclamptic women were positively correlated with the degree of proteinuria (p<0.05, r=0.25), systolic (p<0.05, r=0.25), and diastolic blood pressure (p<0.05, r=0.31). These findings seem to point to an involvement of sVEGFR-1 in the pathophysiology of PE. Serum sVEGFR-1 has the potential to be used as a valuable biomarker in the prediction, diagnosis, and risk management of women with subtypes of PE including mild and severe PE, HELLP syndrome, and eclampsia. There is a need to study serum sVEGFR-1 as a biomarker in pregnant women with different subtypes of PE.

Severe Postpartum HELLP Syndrome: Is This Atypical Hemolytic Uremic Syndrome?

Severe Postpartum HELLP Syndrome: Is This Atypical Hemolytic Uremic Syndrome?

Pregnancy-Associated Haemolytic Uraemic Syndrome

Haemolytic Uraemic Syndrome (HUS) is a rare and severe form of thrombotic microangiopathy associated with a poor renal prognosis. Approximately 10-20% of the diagnoses of atypical Haemolytic Uremic Syndrome (aHUS) are related to pregnancy. Pregnancy acts as a trigger for aHUS, especially in the setting of preeclampsia and haemorrhage. It should be differentiated from other similar conditions such as severe preeclampsia, HELLP syndrome, and severe postpartum haemorrhage.

D Vitamini Seviyesi Preeklampsinin Şiddetini Değiştirir mi? Tek Merkezli Vaka Kontrol Çalışması

Aim: We aimed to investigate the association between vitamin D deficiency and severity of preeclampsia.&#x0D; Material and Methods: We conducted a case-control study aiming to evaluate vitamin D serum levels in patients with preeclampsia(PE), severe preeclampsia, eclampsia and HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets). Total number of 69 patients between the ages of 18 and 40 either had a spontaneous vaginal delivery or C-section were included in the study. &#x0D; Results: The demographic data of the patients were similar, and age was higher in severe PE than in the other groups. When body mass index (BMI) was evaluated, the average BMI of the patients in the severe PE group was found to be significantly higher than PE and similar to the other groups. The average vitamin D levels of all groups was 8.75±3.5 and the mean of severe PE was 6.69±3, which was significantly lower than the other groups. The average vitamin D level in PE was 10.99±2.91, and it was higher than all groups and was significantly higher than patients with severe PE and HELLP syndrome.&#x0D; Conclusion: We think that there is a significant relationship between the severity of hypertensive disorders that begin during pregnancy and the degree of vitamin D deficiency. We think that the control of vitamin D level and its addition to the treatment will positively affect the course of the disease in order to prevent hypertensive disorders and reduce the severity of disease.

Incidence and Risk Factors for Severe Preeclampsia, Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome, and Eclampsia at Preterm and Term Gestation: A Population-based Study

(Am J Obstet Gynecol. 2021;225:538.e1–538.e19) Preeclampsia is a complication of pregnancy that is among the most common in high-income countries and portents other sequelae including severe preeclampsia, eclampsia, and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count syndrome). Prevalence of these serious diagnoses range from 0.2 to 7.6 per 1000 deliveries in high-income countries. The risk factors and gestational age-specific incidence of preeclampsia with severe features, eclampsia and HELLP syndrome is not well characterized, and previous investigations of these outcomes have been hospital-based with small numbers of patients. This study provides a large population-based inquiry into the development of these further related conditions following preeclampsia at term and preterm gestation, along with associations of maternal and clinical factors.

Serum MUC3 Protein as a Novel Marker of Gestational Hypertensive Disorders.

This study aimed to investigate the serum levels of mucoprotein 3 in hypertensive diseases of pregnancy. In total, 60 consecutive women with gestational hypertensive diseases (gestational hypertension (n = 20), severe preeclampsia (n = 20), HELLP syndrome (n = 20)) and 20 pregnant women without any gestational hypertensive diseases were included for this prospective controlled study. Serum MUC3 protein levels were measured with commercially available ELISA kits. Serum MUC3 protein level was the lowest in normal pregnant women (0.1047 ± 0.0295ng/ml); while the severity of the disease increases, it significantly increased in severe preeclampsia (0.2700 ± 0.0199ng/mL) and HELLP syndrome group (0.3494 ± 0.0455ng/mL), but less in the gestational hypertension (0.2172 ± 0.0354ng/mL) group. Mean serum MUC3 protein level differences were found the least in gestational hypertension (0.1125 ± 0.0107, p < 0.001), the most in HELLP syndrome (-0.2546 ± 0.0107, p < 0.001) compared with the pregnant control group. The increase in serum MUC3 protein concentration in these women supported the argument that serum MUC3 protein may be used as a marker indicating the severity of the gestational hypertensive diseases.

The favorable outcome of subsequent pregnancy in a patient with a history of obstetric atypical hemolytic uremic syndrome

Atypical hemolytic uremic syndrome (aHUS) is a severe life-threatening disease associated with uncontrolled activation of alternative complement pathway. Obstetric aHUS, which develops in pregnant women and puerperas, is characterized by a particularly severe course with multiple organ failure, high death risk and end-stage renal disease. The prognosis of patients with obstetric aHUS has changed dramatically after the introduction of eculizumab, a monoclonal antibody to C5 complement component, into clinical practice. With timely initiation of the complement blocking therapy, the patients would not only survive, but also completely restore the function of the affected organs. Naturally, the question arises on the possibility of repeated pregnancies in women with previous obstetric aHUS and on the strategy of pregnancy management.&#x0D; The paper describes a clinical case of successful treatment with eculizumab for obstetric aHUS in the third trimester of the first pregnancy in a young and previously healthy woman, and the management of her second pregnancy. A 23-year old woman at 35-36 weeks of her first pregnancy developed the clinical picture of obstetric thrombotic microangiopathy, which was interpreted as a manifestation of severe preeclampsia and HELLP syndrome. However, after an emergency surgical delivery, the patient's condition continued to deteriorate despite the plasma exchange procedure. After exclusion of the other causes of thrombotic microangiopathy, aHUS was diagnosed and treatment with eculizumab was started, which resulted in complete recovery. No aHUS-associated mutations were identified. The complement inhibitor treatment was discontinued after 12 months. Four years after the first birth, the patient had a second pregnancy after preconception planning. During pregnancy, the patient was closely monitored for a timely identification of potential complications and had prevention of placental complications with acetylsalicylic acid and low molecular weight heparin. No aHUS recurrence and/or other complications were observed, and the patient did not require treatment with eculizumab during pregnancy. Elective caesarean section was performed at 39 week of gestation. A healthy boy was born with a bodyweight of 3370 g, a height of 50 cm, and Apgar score 8-9.&#x0D; In women with obstetric aHUS history, a favorable outcome of repeated pregnancies is possible, in some cases even without any prophylactic use of complement-blocking therapy, provided that with complete remission of aHUS has been achieved, with close monitoring during gestation and prevention of placenta-associated complications.

Severe Maternal Morbidity and Maternal Mortality Associated with Assisted Reproductive Technology

ObjectiveTo assess the association between use of assisted reproductive technologies (ART) and severe maternal morbidity and maternal mortality (SMM). MethodsWe carried out a cohort study that included all hospital deliveries at ≥20 weeks gestation in Canada (excluding Québec) between April 2009 and March 2018. Outcomes of interest included composite SMM and SMM types (e.g., severe preeclampsia, HELLP syndrome, and eclampsia; severe hemorrhage; acute renal failure). Multivariable regression was used to estimate crude and adjusted rate ratios (RR and aRR) and 95% confidence intervals (CI). ResultsThe study included 2 535 056 women, of whom 72 023 (2.8%) delivered following the use of ART. The composite SMM rate for women who used ART was 34.7 per 1000 deliveries (95% CI 33.0–36.0) versus 11.5 per 1000 deliveries (95% CI 11.4–11.6) for women who did not use ART (RR 3.01; 95% CI 2.89–3.14). ART use was associated with SMM types such as severe preeclampsia, HELLP syndrome, and eclampsia (RR 3.50; 95% CI 3.27–3.73), severe hemorrhage (RR 3.58, 95% CI 3.27–3.92), and acute renal failure (RR 6.79; 95% CI 5.78–7.98). Associations between ART and composite SMM were attenuated but remained elevated after adjusting for maternal characteristics (aRR 2.34; 95% CI 2.24–2.45). Women who used ART and had a multi-fetal pregnancy had a 4.7 times higher rate of composite SMM compared with women who did not use ART and delivered singletons. ConclusionWomen who deliver following the use of ART have increased risks of SMM and require counselling that includes mention of the lower risks of SMM associated with ART-conceived singleton pregnancy.