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https://www.readbyqxmd.com/read/29153672/an-intermediate-sflt-1-plgf-ratio-indicates-an-increased-risk-for-adverse-pregnancy-outcome
#1
Janine Hoffmann, Victoria Ossada, Marie Weber, Holger Stepan
OBJECTIVE: The sFlt-1/PlGF ratio is a valid marker in diagnosing or excluding preeclampsia. The currently used cut offs frame an intermediate zone of 33-85 (<34(0) weeks) or 33-110 (≥34(0) weeks), respectively. In this study we sought to evaluate the relevance of an intermediate sFlt-1/PlGF ratio for the clinical pregnancy course and outcome. MATERIAL AND METHODS: We retrospectively analysed 533 consecutive patients with sFlt-1/PlGF ratio measurements for suspected preeclampsia...
October 2017: Pregnancy Hypertension
https://www.readbyqxmd.com/read/29153664/microcirculatory-blood-flow-derangements-during-severe-preeclampsia-and-hellp-syndrome
#2
Gustavo Adolfo Ospina-Tascón, Albaro José Nieto Calvache, Edgardo Quiñones, Humberto José Madriñan, Juan David Valencia, William Fernando Bermúdez, Javier Carvajal, María Fernanda Escobar, Daniel de Backer
OBJECTIVE: To evaluate the microcirculatory blood flow in severe preeclampsia and compare it with healthy pregnant and non-pregnant women controls, using a portable intravital-microscopy technique. METHODS: Using a side-stream dark field (SDF) device, we prospectively evaluated the sublingual microcirculatory blood flow before placental delivery in 40 women with severe preeclampsia (PE-group) complicated (n=8) or not (n=32) with HELLP syndrome, 40 healthy pregnant women (HP-group) matched by gestational and chronological age, and 20 healthy non-pregnant women (NP-group)...
October 2017: Pregnancy Hypertension
https://www.readbyqxmd.com/read/29124521/successful-peritoneal-dialysis-using-a-percutaneous-tube-for-peritoneal-drainage-in-an-extremely-low-birth-weight-infant-a-case-report
#3
Satoshi Yokoyama, Takayuki Nukada, Yuka Ikeda, Shigeto Hara, Akira Yoshida
BACKGROUND: Peritoneal dialysis (PD) for acute kidney injury (AKI) of newborns has been performed safely. AKI occurs in 8 to 24% of extremely low birth weight (ELBW) infants. Although PD has only been used occasionally in ELBW infants, prognosis is poor for ELBW infants with AKI. Several reports have described successful PD in these infants, but no guideline-based evidence concerning indications for renal replacement therapy in ELBW infants are currently available. Here, we report on our experience with PD in an ELBW infant with AKI resulting from septic shock...
November 9, 2017: Surgical Case Reports
https://www.readbyqxmd.com/read/29123569/diagnostic-dilemma-severe-thrombotic-microangiopathy-in-pregnancy
#4
Sarah Birkhoelzer, Alexandra Belcher, Helen Peet
A diagnostic dilemma occurred when thrombotic microangiopathy developed during pregnancy. The diagnostic criteria of thrombotic microangiopathy include thrombocytopenia (platelets <100) and microangiopathic haemolytic anaemia (including thrombotic thrombocytopenic purpura and haemolytic-uraemic syndrome). An urgent interdisciplinary approach is required to treat thrombotic microangiopathy in pregnancy to differentiate between thrombotic microangiopathy and HELLP syndrome (haemolysis, elevated liver enzymes, low platelets)...
November 2017: J Intensive Care Soc
https://www.readbyqxmd.com/read/29117926/-maternal-deaths-due-to-hypertensive-disorders-results-from-the-french-confidential-enquiry-into-maternal-deaths-2010-2012
#5
M Dreyfus, P Weber, L Zieleskiewicz
Between 2010 and 2012, the rate of maternal death caused by hypertensive disorders (0,5/100,000 living birth) was reduced by 50% compared to the 2007-2009 period. Hypertensive disorders were responsible from 5% of maternal deaths and from 10% of direct maternal mortality. Eleven deaths happened during the postpartum period but 9 hypertensive complications began before delivery. Seventy percent of these deaths seem to be avoidable. The main causes of suboptimal management were: unappropriated or insufficient obstetrical and anesthetic treatments, undiagnosed HELLP syndrome and subcapsular liver hematoma, delayed treatment...
November 5, 2017: Gynecologie, Obstetrique, Fertilite & Senologie
https://www.readbyqxmd.com/read/29114416/outcomes-of-antepartum-and-postpartum-obstetric-admissions-to-the-intensive-care-unit-of-a-tertiary-university-hospital-an-8-year-review
#6
Menekşe Özçelik, Sanem Turhan, Onat Bermede, Ali Abbas Yılmaz, Necmettin Ünal, Mustafa Kemal Bayar
Objective: Although their rates are decreasing, pregnancy-related mortality and morbidity are problems worldwide. In this study, we aimed to review the characteristics, diagnoses, required interventions and outcomes of obstetric patients admitted between 2006 and 2014 to the Intensive Care Unit (ICU) of a tertiary university hospital to provide an indicator for improving the management of critically ill obstetric patients. Methods: A retrospective study of hospital records of obstetric admissions to the ICU was conducted...
October 2017: Turkish Journal of Anaesthesiology and Reanimation
https://www.readbyqxmd.com/read/29110117/successful-treatment-of-acute-promyelocytic-leukemia-in-pregnancy-with-single-agent-all-trans-retinoic-acid
#7
REVIEW
Cordula M Nellessen, Viktor Janzen, Karin Mayer, Giulia Giovannini, Ulrich Gembruch, Peter Brossart, Waltraut M Merz
PURPOSE: The diagnosis of acute promyelocytic leukemia (APL) in pregnancy is an uncommon, life-threatening emergency. Choice of treatment and management of complications are challenging. METHODS: We report the case of a patient with diagnosis of APL at gestational age (GA) 24 + 4. We describe the interdisciplinary management during pregnancy and delivery and provide a 2-year follow-up. Existing reports on APL in pregnancy are summarized. RESULTS: Single-agent induction therapy with all-trans retinoic acid (ATRA) was started and resulted in normalization of blood cell counts after 32 days...
November 6, 2017: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/29107602/maternal-ophthalmic-artery-doppler-ultrasonography-in-preeclampsia-and-pregnancy-outcomes
#8
Maria Teresa Pedrazzi Chaves, Sérgio Martins-Costa, Maria Lúcia da Rocha Oppermann, Ricardo Palma Dias, Valentino Magno, Julio Alejandro Peña, José Geraldo Lopes Ramos
OBJECTIVE: To examine the association of ophthalmic artery (OA) Doppler measure - the ratio of velocity peaks (PR) - to adverse pregnancy outcomes in preeclampsia. STUDY DESIGN AND MAIN OUTCOMES: Prospective cohort study of 56 women with preeclampsia that underwent Doppler measurements of OA flow, medial to optic nerve. PR results were classified as normal (PR < 0.78), abnormal (PR 0.78-0.98), or highly abnormal (PR ≥ 0.99). Attending clinicians were blinded to OA Doppler results...
October 19, 2017: Pregnancy Hypertension
https://www.readbyqxmd.com/read/29105301/the-maternal-14%C3%A2-bp-ins-del-polymorphism-in-hla-g-is-not-associated-with-preeclampsia-risk
#9
L C Ferreira, T P B Lopes, T B Guimarães, C E M Gomes, S M B Jeronimo
The effect of HLA-G 14 bp Ins/Del polymorphism (rs371194629) on the risk of preeclampsia has been assessed in several populations, yet the results are still conflicting. Lack of power due to small sample sizes is a common cause of inconsistencies in genetic association studies. We aimed to test whether the maternal polymorphism is associated with preeclampsia, eclampsia or HELLP syndrome (acronym for Hemolysis, Elevation of Liver enzymes, Low Platelets). To achieve a statistical power greater than 0.90, a total of 741 women (332 controls, 246 preeclampsia, 57 eclampsia and 106 HELLP) were genotyped for the 14-bp Ins/Del polymorphism...
November 3, 2017: International Journal of Immunogenetics
https://www.readbyqxmd.com/read/29078925/thrombotic-microangiopathies-ttp-hus-hellp
#10
REVIEW
Shane Kappler, Sarah Ronan-Bentle, Autumn Graham
Thrombocytopenia, strictly defined as a platelet count less than 150,000, is common in the emergency department. Recognition, diagnostic investigation, and proper disposition of a thrombocytopenic patient are imperative. One group of disorders leading to thrombocytopenia is the thrombotic microangiopathies, hallmarked by platelet destruction. These thrombotic microangiopathies include thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS) and hemolysis, elevated liver enzyme levels, low platelet count (HELLP), which should be distinguished from similar disease processes such as immune thrombocytopenia (ITP), disseminated intravascular coagulation (DIC) and heparin induced thrombocytopenia (HIT)...
December 2017: Hematology/oncology Clinics of North America
https://www.readbyqxmd.com/read/29049209/pravastatin-for-prevention-of-hellp-syndrome-a-case-report
#11
Lucia Anna Otten, Katrin van der Ven, Marietta Kühr, Ulrich Gembruch, Waltraut Maria Merz
RATIONALE: Pravastatin has emerged for prevention and treatment of preeclampsia; no reports are available on pravastatin and HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome. PATIENT CONCERNS: The first pregnancy necessitated termination of pregnancy at gestational age (GA) 20+5 for HELLP. Intrauterine fetal death at GA 22+5 occurred in the second pregnancy, whilst on temporizing management of HELLP. DIAGNOSES: Severe, recurrent early-onset HELLP syndrome...
October 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28971558/maternal-cardiac-function-after-hellp-syndrome-an-echocardiography-study
#12
R Orabona, E Vizzardi, E Sciatti, F Prefumo, I Bonadei, A Valcamonico, M Metra, T Frusca
OBJECTIVE: To evaluate maternal hemodynamics in asymptomatic women with a previous pregnancy affected by hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and compare the findings to those of women with previous pre-eclampsia (PE) and controls with a previous uncomplicated pregnancy. METHODS: Women with a history of PE (n = 60) or HELLP syndrome (n = 49) and matched healthy controls (n = 60) underwent echocardiography at 6 months to 4 years after delivery, recording left ventricular (LV) dimensions, ejection fraction (LVEF) and mass, right ventricular (RV) tricuspid annular plane systolic excursion and fractional area change (FAC)...
October 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28971254/placental-pathology-varies-in-hypertensive-conditions-of-pregnancy
#13
Jerzy Stanek
This study was a comprehensive analysis of placental phenotypes in hypertensive conditions of pregnancy, including recently described placental hypoxic lesions and lesions of shallow placentation. To this end, consecutive placentas from > 21 weeks pregnancies that were signed out by the author at 4 tertiary care centers on 3 continents were included. Twenty-four clinical and 50 placental phenotypes were studied in 6 groups and statistically compared: 91 cases of gestational hypertension, 187 cases of mild preeclampsia, 211 cases of severe preeclampsia, 84 cases of HELLP or eclampsia, 127 cases of chronic hypertension, and 55 cases of preeclampsia superimposed on chronic hypertension...
October 2, 2017: Virchows Archiv: An International Journal of Pathology
https://www.readbyqxmd.com/read/28971026/intensive-care-unit-issues-in-eclampsia-and-hellp-syndrome
#14
REVIEW
Melissa Teresa Chu Lam, Elizabeth Dierking
Preeclampsia, eclampsia and HELLP syndrome are life-threatening hypertensive conditions and common causes of ICU admission among obstetric patients The diagnostic criteria of preeclampsia include: 1) systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg on two occasions at least 4 hours apart and 2) proteinuria ≥300 mg/day in a woman with a gestational age of >20 weeks with previously normal blood pressures. Eclampsia is defined as a convulsive episode or altered level of consciousness occurring in the setting of preeclampsia, provided that there is no other cause of seizures...
July 2017: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/28941881/historical-evolution-of-ideas-on-eclampsia-preeclampsia-a-proposed-optimistic-view-of-preeclampsia
#15
Pierre-Yves Robillard, Gustaaf Dekker, Gérard Chaouat, Marco Scioscia, Silvia Iacobelli, Thomas C Hulsey
Eclampsia (together with epilepsy) being the first disease ever written down since the beginning of writings in mankind 5000 years ago, we will make a brief presentation of the different major steps in comprehension of Pre-eclampsia. 1) 1840. Rayer, description of proteinuria in eclampsia, 2) 1897 Vaquez, discovery of gestational hypertension in eclamptic women, 3) In the 1970's, description of the "double" trophoblastic invasion existing only in humans (Brosens & Pijnenborg,), 4) between the 1970's and the 1990's, description of preeclampsia being a couple disease...
September 2017: Journal of Reproductive Immunology
https://www.readbyqxmd.com/read/28934089/postpartum-hemorrhage-with-transfusion-trends-near-misses-risk-factors-and-management-at-the-scale-of-a-perinatal-network
#16
M Marocchini, J Lauféron, C Quantin, P Sagot
OBJECTIVES: To analyze temporal trends and management of postpartum hemorrhage (PPH) with transfusion and its related maternal near-miss (MNM) cases between 2006 and 2014 and to study risk factors. MATERIAL AND METHODS: This retrospective cohort study from two prospective databases included 156,047 women giving birth in all the maternity hospitals of Burgundy. We analyzed temporal trends and the distribution of PPH with transfusion, the circumstances of transfer of patients between hospitals and factors associated with PPH with transfusion...
May 2017: Journal of gynecology obstetrics and human reproduction
https://www.readbyqxmd.com/read/28929001/recurrent-hellp-syndrome-at-22-weeks-of-gestation
#17
Peter Kascak, Milos Paskala, Peter Antal, Radovan Gajdosik
We describe a case of a woman who presented with HELLP syndrome in two subsequent pregnancies (age 36 and 40), at gestational age of 22 weeks in both pregnancies with a rapid onset and progression. She presented with characteristic clinical symptoms and laboratory findings. Both pregnancies were delivered by caesarean sections due to deterioration in the mother's condition, although neither pregnancy progressed into the 1st stage of the syndrome according to Mississippi classification. This case highlights the admittedly rare but serious condition of recurring HELLP syndrome at a gestational age before the limit of viability of the fetus...
2017: Case Reports in Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28912922/obstetric-outcomes-of-twin-pregnancies-in-japanese-women-aged-40-and-older
#18
Shunji Suzuki
BACKGROUND: The aim of this study was to compare the obstetric outcomes of twin pregnancies between Japanese women aged ≥ 40 years and their younger counterparts aged 25 - 29. METHODS: This was a retrospective study of twin pregnancies managed at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2016. Women aged 40 and older at delivery (n = 117) were compared with women aged 25 - 29 at delivery (n = 536). RESULTS: Although the women ≥ 40 years old were more likely to have increased risks of HELLP (hemolytic, elevated liver enzymes and low platelet) syndrome and very low birth weight neonates, there were no measurable differences in obstetric outcomes such as hypertensive disorders, premature delivery and neonatal asphyxia between the two groups...
October 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/28893157/basal-plate-myometrial-fibers-and-hypertensive-disorders-of-pregnancy-a-case-control-study
#19
Ann A Wang, Linda M Ernst, Emily S Miller
Introduction Basal plate myometrium (BPMYO), the pathological presence of myometrial fibers in the basal plate, is a common finding on pathological examination of the placenta, yet its clinical correlates are not well studied. As myometrial fibers are frequently located in proximity to poorly converted maternal spiral arteries, our objective was to determine whether BPMYO is associated with hypertensive disorders of pregnancy (HDP), a well-known clinical sequela of abnormal maternal artery remodeling. Methods This case-control study included women who delivered a live-born singleton gestation whose placentas were sent for pathological examination...
January 1, 2017: Pediatric and Developmental Pathology
https://www.readbyqxmd.com/read/28867885/serious-visual-ocular-complications-in-pre-eclampsia-and-eclampsia
#20
Thangappah Radha Bai Prabhu
INTRODUCTION: Complete loss of vision is an uncommon ocular complication of pre-eclampsia/eclampsia. The conditions which lead to visual loss in pre-eclampsia include cortical blindness, retinal detachment, retinal vascular thrombosis and optic nerve atrophy. OBJECTIVES: The objective was to describe the cause, clinical course and prognosis in blindness complicating pre-eclampsia. METHODOLOGY: This is a prospective observational study conducted at the Govt...
October 2017: Journal of Obstetrics and Gynaecology of India
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