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https://www.readbyqxmd.com/read/29691249/hypertensive-pregnancy-complications-in-women-with-epilepsy-and-antiepileptic-drugs-a-population-based-cohort-study-of-first-pregnancies-in-norway
#1
Kim Christian Danielsson, Ingrid Borthen, Nils-Halvdan Morken, Nils Erik Gilhus
OBJECTIVES: To estimate the risk of hypertensive pregnancy complications in women with epilepsy, with and without antiepileptic drugs, and assess the risk associated with the four most common antiepileptic drugs. DESIGN: A population-based cohort study using linked data from the Medical Birth Registry of Norway and the Norwegian Prescription Database. Women with epilepsy with and without antiepileptic drugs were compared with women without epilepsy. SETTING: Norway, 2004-2012...
April 24, 2018: BMJ Open
https://www.readbyqxmd.com/read/29674195/thrombotic-microangiopathies-of-pregnancy-differential-diagnosis
#2
REVIEW
M Gupta, B B Feinberg, R M Burwick
Thrombotic microangiopathy (TMA) disorders are characterized by microangiopathic hemolytic anemia, thrombocytopenia and end-organ injury. In pregnancy and postpartum, TMA is most commonly encountered with HELLP (hemolysis, elevated liver enzymes, low platelet count syndrome) or preeclampsia with severe features, but rarely TMA is due to thrombotic thrombocytopenic purpura (TTP) or atypical hemolytic uremic syndrome (aHUS). Due to overlapping clinical and laboratory features, TTP and aHUS are often mistaken for preeclampsia or HELLP...
February 16, 2018: Pregnancy Hypertension
https://www.readbyqxmd.com/read/29673002/incidence-of-and-risk-factors-for-severe-maternal-complications-associated-with-hypertensive-disorders-after-36-weeks-gestation-in-uncomplicated-twin-pregnancies-a-prospective-cohort-study
#3
Ryo Yamamoto, Keisuke Ishii, Haruka Muto, Shiyo Ota, Haruna Kawaguchi, Shusaku Hayashi, Nobuaki Mitsuda
AIM: To elucidate the incidence of and risk factors for severe hypertensive disorders (HD) and related maternal complications in uncomplicated twin pregnancies that reached 36 weeks' gestation. METHODS: We conducted a prospective cohort study of twin pregnancies delivered after 36 weeks' gestation. Cases of twin-twin transfusion syndrome, twin anemia-polycythemia sequence, malformed fetuses, monoamniotic twins, selective reduction, fetal therapy and HD or fetal death before 35 weeks' gestation were excluded...
April 19, 2018: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/29662967/maternal-serum-uric-acid-level-and-maternal-and-neonatal-complications-in-preeclamptic-women-a-cross-sectional-study
#4
Maryam Asgharnia, Fariba Mirblouk, Soudabeh Kazemi, Davood Pourmarzi, Mina Mahdipour Keivani, Seyedeh Fatemeh Dalil Heirati
Background: Preeclampsia is associated with maternal and neonatal complications. It has been indicated that increased uric acid might have a predictive role on preeclampsia. Objective: We aimed to investigate the relationship between the level of uric acid with maternal and neonatal complications in women with preeclampsia. Materials and Methods: In this cross-sectional study, 160 singleton preeclamptic women at more than 28 wk gestational age were included...
September 2017: International Journal of Reproductive Biomedicine (Yazd, Iran)
https://www.readbyqxmd.com/read/29644153/acute-fatty-liver-of-pregnancy-a-thorough-examination-of-a-harmful-obstetrical-syndrome-and-its-counterparts
#5
Joshua Ronen, Shahzeb Shaheen, David Steinberg, Kevin R Justus
Diagnosed in one of every 20,000 deliveries, acute fatty liver of pregnancy (AFLP) was considered to be a deadly disease for many years. However, advancements in the clinical and surgical management of pregnant mothers have lead to a drastic decrease in maternal morbidity and mortality. The corresponding case recounts a 23-year-old gravida 2 para 1 (G2P1) at 38 weeks gestational age (GA) with no relevant past medical or family medical history that presented to the emergency department (ED) with a five-day history of nausea, protracted vomiting, hypertension, and new-onset headache...
February 6, 2018: Curēus
https://www.readbyqxmd.com/read/29563339/germline-mutations-in-the-alternative-pathway-of-complement-predispose-to-hellp-syndrome
#6
Arthur J Vaught, Evan M Braunstein, Jagar Jasem, Xuan Yuan, Igor Makhlin, Solange Eloundou, Andrea C Baines, Samuel A Merrill, Shruti Chaturvedi, Karin Blakemore, C John Sperati, Robert A Brodsky
BACKGROUND: HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is a severe variant of hypertensive disorders of pregnancy affecting approximately 1% of all pregnancies, and has significant maternal and fetal morbidity. Previously, we showed that upregulation of the alternative pathway of complement (APC) plays a role in HELLP syndrome. We hypothesize that HELLP syndrome follows a 2-hit disease model similar to atypical hemolytic uremic syndrome (aHUS), requiring both genetic susceptibility and an environmental risk factor...
March 22, 2018: JCI Insight
https://www.readbyqxmd.com/read/29478361/hepatic-rupture-associated-with-preeclampsia-report-of-three-cases-and-literature-review
#7
María Fernanda Escobar Vidarte, Daniela Montes, Alejandra Pérez, Sara Loaiza-Osorio, Albaro José Nieto Calvache
BACKGROUND: Hepatic rupture is a complication during pregnancy that, although rare, accounts for high morbidity and mortality rates. It is mainly associated with severe preeclampsia and HELLP syndrome. Incidence is estimated to be at one per 67 000 births or one per 2000 patients with preeclampsia/eclampsia/HELLP, mainly in multiparous women; women in their 40s; after 32 weeks of gestation; and during the first 15 hours postpartum Cases: This article exposes the institutional experience at Fundación Valle del Lili in Cali, Colombia, in managing and treating hepatic rupture associated with severe preeclampsia and HELLP syndrome in three patients in the 30th, 26th and 27th week of gestation, not resulting in maternal death...
February 25, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29466901/modified-isth-pregnancy-specific-dic-score-in-parturients-with-liver-rupture-population-based-case-series
#8
Ranit Hizkiyahu, Anat Rabinovich, Jecko Thachil, Eyal Sheiner, Gad Shaked, Gilbert Sebbag, Eli Maymon, Offer Erez
OBJECTIVES: Liver rupture and hematoma are rare life-threatening complications of pregnancy. The aims of the current study are to: (1) characterize in a population-based study all cases of liver hematoma and/or rupture; and (2) validate the utility of the International Society on Thrombosis and Haemostasis (ISTH) modified pregnancy specific disseminated intravascular coagulation (DIC) score in those cases. STUDY DESIGN: A retrospective cohort study including all patients with liver subcapsular hematoma or rupture between the years 1996 and 2012 was conducted...
February 21, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29450378/ocular-posterior-pole-pathological-modifications-related-to-complicated-pregnancy-a-review
#9
REVIEW
Vanessa Andrada Păun, Zamfir-Radu Ionescu, Liliana Voinea, Monica Cîrstoiu, Alexandru Baroș, Ștefan Pricopie, Radu Ciuluvică
Ocular posterior pole modification are a pathological manifestation in complicated pregnancies, especially when pregnancy induced hypertension is present (PIH), as well as in preeclampsia (PE) or eclampsia. Nonetheless, as the pregnancy evolves, the possibility for an aggravated evolution with HELLP syndrome, disseminated intravascular coagulation, and idiopathic thrombocytopenic purpura may have an ocular manifestation that, mainly, implies a loss of visual field or acuity, that, left unattended, may constitute a permanent impairment...
April 2017: Romanian Journal of Ophthalmology
https://www.readbyqxmd.com/read/29430625/hellp-syndrome-risk-factors-in-first-and-second-pregnancy-a-population-based-cohort-study
#10
Ola Malmström, Nils-Halvdan Morken
INTRODUCTION: HELLP syndrome may have specific risk factors and risk factors varying from first to second pregnancy. The aims of the study were to estimate the risk of HELLP syndrome by potential risk factors in first and second pregnancy, respectively. MATERIAL AND METHODS: A population based cohort study including all women in Norway having their first baby (≥22 gestational weeks) during 1999 to 2014, registered in the Medical Birth Registry (n=418 897). A subset of women with at least two births (n=249 070) was used for estimates in second pregnancy...
February 11, 2018: Acta Obstetricia et Gynecologica Scandinavica
https://www.readbyqxmd.com/read/29403592/management-of-retinal-diseases-in-pregnant-patients
#11
REVIEW
Julie M Rosenthal, Mark W Johnson
Pregnancy leads to significant changes in the body, which potentially affect the retina. Pregnancy can induce disease, such as that seen in hypertensive retinopathy and choroidopathy. It can cause exudative retinal detachments in the HELLP syndrome (hemolysis, elevated liver enzymes and low platelets), disseminated intravascular coagulation (DIC), and thrombotic thrombocytopenic purpura (TTP), and provoke arterial and venous retinal occlusive disease. Pregnancy may also exacerbate pre-existing retinal disease, such as idiopathic central serous chorioretinopathy (ICSC) and diabetic retinopathy...
January 2018: Journal of Ophthalmic & Vision Research
https://www.readbyqxmd.com/read/29348275/microangiopathies-in-pregnancy
#12
Jailan Elayoubi, Kavitha Donthireddy, Divyesh Reddy Nemakayala
Thrombotic thrombocytopenic purpura (TTP) is a potentially reversible, life-threatening medical emergency. We present a case of a 21-year-old female with evidence of haemolytic anaemia based on the presence of positive markers of haemolysis. Negative Coomb's test, thrombocytopenia and placental infarcts raised suspicion for a thrombotic microangiopathy. She was diagnosed with TTP and managed with emergency plasma exchange. Her recovery was immediate.A presumptive diagnosis of TTP should be based on the presence of microangiopathic haemolytic anaemia with thrombocytopenia and plasma exchange should be initiated while complete work up is pending...
January 17, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29345041/serum-amyloid-a-procalcitonin-highly-sensitive-c-reactive-protein-and-tumor-necrosis-factor-alpha-levels-and-acute-inflammatory-response-in-patients-with-hemolysis-elevated-liver-enzymes-low-platelet-count-hellp-and-eclampsia
#13
Kazım Uckan, Hanım Guler Sahin
AIM: The aim of this study was to determine the relationship between serum amyloid A (SAA), procalcitonin (ProC), highly sensitive C reactive protein (hsCRP) and tumor necrosis factor (TNF) alpha activity in patients with pre-eclampsia, eclampsia and hemolysis, elevated liver enzymes, low platelet count (HELLP), and the pathogenesis and severity of the disease. METHOD: Ninety patients at ≥ 32 gestational weeks, according to the last date of menstruation and ultra-sonographic measurements, diagnosed with pre-eclampsia (30 patients), eclampsia (30 patients) or HELLP syndrome (30 patients) were included in the study...
March 2018: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/29331477/atypical-presentation-of-pregnancy-related-hemolytic-uremic-syndrome
#14
Salim Baghli, Catherine Abendroth, Umar Farooq, Jennifer A Schaub
The cause of acute kidney injury during pregnancy and in the postpartum period can be particularly challenging to diagnose, especially when it is necessary to differentiate among preeclampsia; eclampsia; hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome; and thrombotic microangiopathies (TMAs). All these disease entities can present with kidney failure, microangiopathic hemolytic anemia, and thrombocytopenia. We present a teaching case of atypical hemolytic uremic syndrome in the postpartum period in a young woman who was found to have mutations of uncertain clinical significance in the complement cascade, including in C3, CFH, and CFI...
January 10, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29321548/role-and-mechanism-of-at1-aa-in-the-pathogenesis-of-hellp-syndrome
#15
Shurui Bu, Yuxian Wang, Shuqing Sun, Yanqian Zheng, Zhu Jin, Jianming Zhi
HELLP syndrome remains a leading cause of maternal and neonatal mortality and morbidity worldwide, which symptoms include hemolysis, elevated liver enzymes and low platelet count. The objective of this study was to determine whether HELLP is associated with AT1-AA. The positive rate and titer of AT1-AA in plasma from pregnant women were determined, and the correlation of AT1-AA titer with the grade of HELLP was analyzed. A HELLP rat model established by intravenous injection of AT1-AA. Our experimental results show the AT1-AA titer and positive rate were significantly higher in HELLP group, and AT1-AA titer were positively correlated with the level of TNF-α and ET-1 in plasma and the grade of HELLP syndrome...
January 10, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29311569/hepatic-dysfunction-and-thrombocytopenia-induced-by-excess-sflt1-in-mice-lacking-endothelial-nitric-oxide-synthase
#16
Yuji Oe, Mieko Ko, Tomofumi Fushima, Emiko Sato, S Ananth Karumanchi, Hiroshi Sato, Junichi Sugawara, Sadayoshi Ito, Nobuyuki Takahashi
Liver dysfunction is a major problem in patients with severe preeclampsia (PE), hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, or in patients receiving anti-vascular endothelial growth factor (VEGF) therapy. Excessive soluble fms-like tyrosine kinase 1 (sFlt1) that antagonizes VEGF has been implicated in the pathogenesis of PE. VEGF increases the expression of endothelial nitric oxide synthase (eNOS) and activates it. eNOS polymorphisms that cause reduced NO production are associated with PE...
January 8, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29302904/acute-kidney-injury-in-pregnancy-with-special-reference-to-pregnancy-specific-disorders-a-hospital-based-study-2014-2016
#17
Jai Prakash, Vivek C Ganiger, Suraj Prakash, Mohammad Iqbal, Deba Prasad Kar, Usha Singh, Ashish Verma
INTRODUCTION: There are numerous reports in the literature describing acute kidney injury in pregnancy (P-AKI) due to various obstetric complications. However, there is a dearth of studies on AKI related to pregnancy-specific disorders from India. We aimed to analyze clinical features and outcome of P-AKI related to pregnancy-specific disorders compared to total pregnancy, in India. METHOD: All pregnant women attending the department of Obstetrics and Gynecology from November 2014 to July 2016 were screened for AKI based on: (1) sudden elevation of serum creatinine ≥ 1 mg/dl; (2) oligoanuria for > 12 h; and (3) need for dialysis...
February 2018: Journal of Nephrology
https://www.readbyqxmd.com/read/29296808/severe-reduction-of-free-form-adamts13-unbound-to-von-willebrand-factor-in-plasma-of-patients-with-hellp-syndrome
#18
Yoko Yoshida, Masanori Matsumoto, Hideo Yagi, Ayami Isonishi, Kazuya Sakai, Masaki Hayakawa, Yuji Hori, Toshiyuki Sado, Hiroshi Kobayashi, Yoshihiro Fujimura
Severely decreased ADAMTS13 unbound to VWF may play a key role in the pathogenesis of HELLP syndrome.A qualitative ADAMTS13 assay may be important for diagnosing HELLP syndrome.
September 12, 2017: Blood Advances
https://www.readbyqxmd.com/read/29284893/anesthetic-management-of-a-parturient-with-hemolysis-elevated-liver-enzyme-levels-and-low-platelet-syndrome-complicated-by-renal-insufficiency-and-coagulopathy
#19
Jinguo Wang, Na Wang, Wei Han, Zhanyang Han
The objective of this study is to describe the anesthetic management of a parturient with hemolysis, elevated liver enzyme levels, and low platelet (HELLP) syndrome and renal insufficiency. A 28-year-old female patient, gestational age of 35 weeks, with hypertensive crisis (blood pressure 190/110 mmHg), was admitted for an emergency cesarean section after diagnosis of HELLP syndrome and renal insufficiency. We performed total intravenous general anesthesia with rapid sequence induction. During the surgical procedure, reduced urine output and coagulopathy were detected...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29282226/maternal-and-fetal-outcomes-of-pregnancies-in-women-with-atypical-hemolytic-uremic-syndrome
#20
Martina Gaggl, Christof Aigner, Dorottya Csuka, Ágnes Szilágyi, Zoltán Prohászka, Renate Kain, Natalja Haninger, Maarten Knechtelsdorfer, Raute Sunder-Plassmann, Gere Sunder-Plassmann, Alice Schmidt
Atypical HUS (aHUS) is a disorder most commonly caused by inherited defects of the alternative pathway of complement, or the proteins that regulate this pathway, and life-threatening episodes of aHUS can be provoked by pregnancy. We retrospectively and prospectively investigated 27 maternal and fetal pregnancy outcomes in 14 women with aHUS from the Vienna Thrombotic Microangiopathy Cohort. Seven pregnancies (26%) were complicated by pregnancy-associated aHUS (p-aHUS), of which three appeared to be provoked by infection, bleeding, and curettage, and three individuals were considered to have preeclampsia/HELLP syndrome before the definitive diagnosis of p-aHUS was made...
March 2018: Journal of the American Society of Nephrology: JASN
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