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https://www.readbyqxmd.com/read/29348275/microangiopathies-in-pregnancy
#1
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
#2
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...
January 18, 2018: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/29331477/atypical-presentation-of-pregnancy-related-hemolytic-uremic-syndrome
#3
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
#4
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
#5
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
#6
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...
January 4, 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
#7
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
#8
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
#9
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...
December 27, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/29281843/liver-injury-in-hemolysis-elevated-liver-enzymes-and-low-platelets-syndrome-measured-by-diffusion-weighted-magnetic-resonance-imaging
#10
David B Nelson, Ambereen Khan, April Bailey, Takeshi Yokoo, Ivan Pedrosa, Donald D McIntire, F Gary Cunningham
OBJECTIVE:  The objective of this study was to evaluate acute liver injury (ALI) detected by diffusion-weighted magnetic resonance imaging (MRI) and the associated laboratory findings in women with hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome. STUDY DESIGN:  This was a retrospective, observational study of women with HELLP syndrome defined by serum aspartate aminotransferase (AST) levels ≥100 U/L and thrombocytopenia with platelets ≤100,000/µL...
December 27, 2017: American Journal of Perinatology
https://www.readbyqxmd.com/read/29272998/risk-factors-and-outcome-of-patients-with-eclampsia-at-a-tertiary-hospital-in-egypt
#11
Ahmad Mahran, Hashem Fares, Reham Elkhateeb, Mahmoud Ibrahim, Haitham Bahaa, Ahmad Sanad, Alaa Gamal, Mohamed Zeeneldin, Eissa Khalifa, Ahmed Abdelghany
BACKGROUND: Eclampsia is a major cause of maternal and neonatal morbidity and mortality in low and middle income countries. The aim of this study was to assess the risk factors and maternal and perinatal outcome in patients with eclampsia in order to get reliable data that helps in reducing the incidence and improving the outcome in an area with high incidence of eclampsia. METHODS: Retrospective study including 250 patients diagnosed with eclampsia at Minia Maternity University Hopsital, Minia, Egypt in the period between January 2013 and December 2014...
December 22, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29237307/oligohydramnios-is-an-independent-risk-factor-for-perinatal-morbidity-among-women-with-preeclampsia-who-delivered-preterm
#12
Alex Rabinovich, Keren Holtzman, Ilana Shoham-Vardi, Moshe Mazor, Offer Erez
PURPOSE: Determine the relationship between oligohydramnios and adverse maternal and neonatal outcomes in a unique cohort of preterm preeclamptic patients. MATERIALS AND METHODS: A retrospective matched case control study comparing 81 preterm parturients (28 0/7 and 36 6/7 weeks) with preeclampsia and oligohydramnios to 81 preterm preeclamptic patients with a normal amniotic fluid index (AFI). RESULTS: 4.8 percent of all our preterm preeclamptic patients had oligohydramnios...
December 13, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29228827/conservative-versus-active-management-in-hellp-syndrome-results-from-a-cohort-study
#13
Marie Cavaignac-Vitalis, Fabien Vidal, Caroline Simon-Toulza, Pierre Boulot, Paul Guerby, Elodie Chantalat, Olivier Parant
OBJECTIVE: HELLP syndrome exposes to severe maternal and fetal complications. Prompt delivery is thus recommended after 34 weeks of gestation, or earlier in case of nonreassuring maternofetal conditions. However, no consensus has been raised in the treatment of HELLP syndrome occurring before 34 weeks of gestation, when both maternal and fetal conditions are stable: it remains still unclear whether an active attitude should be prioritized over expectant management. Herein, we aimed to compare mother and child outcomes according to the type of obstetrical management, either active or conservative...
December 21, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29181841/epidural-therapy-for-the-treatment-of-severe-pre-eclampsia-in-non-labouring-women
#14
REVIEW
Amita Ray, Sujoy Ray
BACKGROUND: Pre-eclampsia is a pregnancy-specific multi-organ disorder, which is characterised by hypertension and multisystem organ involvement and which has significant maternal and fetal morbidity and mortality. Failure of the placental vascular remodelling and reduced uteroplacental flow form the etiopathological basis of pre-eclampsia. There are several established therapies for pre-eclampsia including antihypertensives and anticonvulsants. Most of these therapies aim at controlling the blood pressure or preventing complications of elevated blood pressure, or both...
November 28, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29153672/an-intermediate-sflt-1-plgf-ratio-indicates-an-increased-risk-for-adverse-pregnancy-outcome
#15
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 (<340 weeks) or 33-110 (≥340 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
#16
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
#17
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
#18
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: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/29117926/-maternal-deaths-due-to-hypertensive-disorders-results-from-the-french-confidential-enquiry-into-maternal-deaths-2010-2012
#19
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
#20
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
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