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Lucia M, Viviana M, Alba C, Giulia D, Carlo DR, Grazia PM, Luca T, Federica VM, Immacolata VA, Grazia PM. Neurological Complications in Pregnancy and the Puerperium: Methodology for a Clinical Diagnosis. J Clin Med 2023; 12:jcm12082994. [PMID: 37109329 PMCID: PMC10141482 DOI: 10.3390/jcm12082994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/06/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Neurological complications in pregnancy and the puerperium deserve particular attention from specialists due to the worsening of the clinical picture for both the mother and the fetus. This narrative review of existing data in the literature aims to analyze the most common "red flag symptoms" attributable to neurological complications such as pre-eclampsia (PE), eclampsia, HELLP syndrome, posterior reversible encephalopathy syndrome (PRES), cerebral vasoconstriction syndrome (RCVS), stroke, CVS thrombosis, pituitary apoplexy, amniotic fluid embolism and cerebral aneurysm rupture, with the aim of providing a rapid diagnostic algorithm useful for the early diagnosis and treatment of these complications. The data were derived through the use of PubMed. The results and conclusions of our review are that neurological complications of a vascular nature in pregnancy and the puerperium are conditions that are often difficult to diagnose and manage clinically. For the obstetrics specialist who is faced with these situations, it is always important to have a guide in mind in order to be able to unravel the difficulties of clinical reasoning and promptly arrive at a diagnostic hypothesis.
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Affiliation(s)
- Merlino Lucia
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Matys Viviana
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Crognale Alba
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - D'Ovidio Giulia
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Della Rocca Carlo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, 04100 Latina, Italy
| | - Porpora Maria Grazia
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Titi Luca
- Department of Anesthesia and Intensive Care Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Viscardi Maria Federica
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Volpicelli Agnese Immacolata
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Piccioni Maria Grazia
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
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Akre S, Sharma K, Chakole S, Wanjari MB. Eclampsia and Its Treatment Modalities: A Review Article. Cureus 2022; 14:e29080. [PMID: 36249647 PMCID: PMC9555679 DOI: 10.7759/cureus.29080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Hypertension in pregnancy is one of the major contributors to mortality and morbidity. Pregnant women and fetuses are both at high risk of the severe complications of preeclampsia known as eclampsia. Eclampsia is a disorder that requires immediate detection and treatment. Eclampsia and preeclampsia during pregnancy are known to cause morbidity and even death in both the mother and fetus if not properly diagnosed. Chronic hypertension, prenatal hypertension, preeclampsia on top of chronic hypertension, and eclampsia are the four types of hypertension. Preeclampsia is the precursor to eclampsia. Associated with end-organ failure and proteinuria after 20 weeks of pregnancy, preeclampsia is characterized by the development of hypertension with systolic blood pressure (BP) of at least 140 mmHg and/or diastolic BP of at least 90 mmHg. It can lead to the failure of the liver, thrombocytopenia, pulmonary edema, central nervous system (CNS) abnormalities, and renal dysfunction. The emergence of new generalized tonic-clonic seizures in a pregnant woman with preeclampsia is known as eclampsia. Eclamptic seizures can happen prior to delivery, 20 weeks following conception, during delivery, and after delivery. Although rare, gestational trophoblastic illness has been associated with seizures that start before 20 weeks. In this article, we examine the pathogenesis, causes, signs, symptoms, and treatment modalities in patients with eclampsia.
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Madaan S, Jaiswal A, Acharya N, Tayade S, Dhok A, Kumar S, Acharya S, Dewani D, Talwar D, Halani D, Reddy Eleti M. Role of Salivary Uric Acid Versus Serum Uric Acid in Predicting Maternal Complications of Pre-Eclampsia in a Rural Hospital in Central India: A Two-Year, Cross-Sectional Study. Cureus 2022; 14:e23360. [PMID: 35475103 PMCID: PMC9020463 DOI: 10.7759/cureus.23360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background Hypertensive disorders during pregnancy are an important topic of concern, specifically in rural and remote areas of India where there is a lack of awareness and it is difficult to maintain proper follow-up of pregnant females to screen them for complications developed during pregnancy. Gestational hypertension and pre-eclampsia result in the abruption of the placenta, hemolysis, elevated liver enzymes, low platelet count syndrome, eclampsia, and disseminated intravascular coagulation, which can be a serious threat to the health of the mother and the fetus. Therefore, it is important to identify biomarkers for diagnosing and predicting the complications of pre-eclampsia that may aid the obstetric high-dependency units based in rural areas to tackle this important health hazard during pregnancy. Methodology A total of 180 singleton pregnant women of more than 34 weeks of gestational age were enrolled in this study. All women were divided into three groups (control group, severe pre-eclampsia, and non-severe pre-eclampsia) based on the severity of blood pressure and the presence of proteinuria (≥+1 by the dipstick method). Salivary and serum uric acid levels were measured through morning samples, and all patients were monitored for the development of complications and outcomes. Salivary uric acid and serum uric acid levels were correlated with each other and with maternal complications of pre-eclampsia. Results Mean salivary uric acid (mg/dL) in severe pre-eclampsia was (6.72 ± 0.49) significantly higher compared to non-severe pre-eclampsia (4.75 ± 0.94) and control (3.13 ± 0.43). Mean serum uric acid (mg/dL) in severe pre-eclampsia was (8.13 ± 0.87) significantly higher compared to non-severe pre-eclampsia (6.23 ± 0.76) and control (3.85 ± 0.46).The lowest best cut-off value of maternal salivary uric acid was 5.06 mg/dL, above which one can predict maternal complications with a diagnostic accuracy of 78.33%. Conclusions Salivary uric acid and serum uric acid levels are significantly raised in cases of pre-eclampsia in comparison to normal pregnancy. Salivary uric acid and serum uric acid are correlated significantly indicating that salivary uric acid can function as a cost-effective, novel marker to provide an idea about serum uric acid levels. The prognostic accuracy of salivary uric acid was good in predicting maternal complications among cases of pre-eclampsia (severe and non-servere) and early-onset maternal complications. Therefore, it may be utilized as a helpful marker to identify high-risk patients.
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Inappropriate left ventricular mass after HELLP syndrome inappropriate LVM after HELLP syndrome. Pregnancy Hypertens 2021; 27:16-22. [PMID: 34844072 DOI: 10.1016/j.preghy.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Excessive left ventricular mass (LVM) results in inefficient LV work with energy waste leading to a negative prognostic effect. We aimed at investigating the presence of inappropriate LVM and calculating the myocardial mechano-energetic efficiency index (MEEi) in former pre-eclamptic (PE) women (with or without HELLP syndrome) compared to women who experienced HELLP syndrome without PE. STUDY DESIGN In this cross-sectional study, women with a history of normotensive HELLP (n = 32), PE without HELLP (n = 59), and PE with HELLP (n = 101) underwent echocardiography as part of the clinical CV work-up after their complicated pregnancies from 6 months to 4 years postpartum. We excluded women with comorbidities, including chronic hypertension, hypercholesterolemia, and obesity. MAIN OUTCOME MEASURES LVM excess was calculated as the ratio between observed LVM and predicted LVM (by sex, stroke work and height), while MEEi was considered as the ratio between stroke work and "double product" (to approximate energy consumption), indexed to LVM. RESULTS LV hypertrophy was present in 8-14% and concentric remodeling in 31-42% of women, without intergroup difference. LVM was inappropriate in one-third of normotensive former HELLP and in about one-half of PE with or without HELLP, with no difference among groups. Accordingly, without nominal difference, MEEi showed a tendency towards lower values in former pre-eclamptic individuals. CONCLUSIONS Women with a history of HELLP syndrome, independently from the presence/absence of PE, showed inappropriate LVM in the first 4 years after delivery, which may partially explain the elevated CV risk in these women compared to the general female population.
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Sciatti E, Mohseni Z, Orabona R, Mulder EG, Prefumo F, Lorusso R, Frusca T, Ghossein-Doha C, Spaanderman ME. Maternal myocardial dysfunction after hemolysis, elevated liver enzymes, and low platelets syndrome: a speckle-tracking study. J Hypertens 2021; 39:1956-1963. [PMID: 34173798 PMCID: PMC10231931 DOI: 10.1097/hjh.0000000000002901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/10/2021] [Accepted: 04/29/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Pregnancy complicated by pre-eclampsia (PE) and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is associated with an increased risk of cardiovascular (CV) diseases later in life. Subclinical cardiac alterations precede eminent CV diseases. Speckle-tracking echocardiography (STE) is an effective method to assess subclinical myocardial dysfunction. We performed a myocardial speckle tracking study to investigate the prevalence of subclinical myocardial dysfunction in former PE patients (with and without HELLP syndrome) compared to normotensive women affected by HELLP syndrome. METHODS In this cross-sectional retrospective study, women with a history of normotensive HELLP (n = 32), PE without HELLP (n = 59), and PE with HELLP (n = 101) underwent conventional and STE as part of the clinical CV work-up after their complicated pregnancies from 6 months to 4 years postpartum. We excluded women with comorbidities, including chronic hypertension, hypercholesterolemia, and obesity. RESULTS Women with a history of PE with HELLP syndrome were characterized by a higher prevalence of altered left ventricular circumferential and global longitudinal two-dimensional (2D) strain (74 and 20%, respectively), altered right ventricular longitudinal 2D strain (37%), and left atrial (LA) 2D strain (57%). Moreover, a higher proportion of alterations of biventricular and LA strains was also present in former PE without HELLP as well as in the normotensive HELLP group. CONCLUSIONS In the first years after a pregnancy complicated by HELLP syndrome, irrespective of whether there was concomitant PE, a higher rate of abnormal STE myocardial function is observed. Therefore, these women may benefit from CV risk management.
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Affiliation(s)
- Edoardo Sciatti
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Center (MUMC), The Netherlands
| | - Zenab Mohseni
- Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), The Netherlands
| | - Rossana Orabona
- Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), The Netherlands
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Eva G. Mulder
- Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), The Netherlands
| | - Federico Prefumo
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Center (MUMC), The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Tiziana Frusca
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
- Department of Obstetrics and Gynecology, University of Parma, Italy
| | - Chahinda Ghossein-Doha
- Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), The Netherlands
- Department of Cardiology, Heart & Vascular Centre, Maastricht University Medical Center (MUMC), The Netherlands
| | - Marc E.A. Spaanderman
- Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), The Netherlands
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Quevedo S, Bekele C, Thompson PD, Philkhana M, Virani S, Consuegra A, Douglass P, Gertz AM. Peripartum cardiomyopathy and HELLP syndrome in a previously healthy multiparous woman: A case report. SAGE Open Med Case Rep 2021; 8:2050313X20979288. [PMID: 33425357 PMCID: PMC7758651 DOI: 10.1177/2050313x20979288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/11/2020] [Indexed: 01/19/2023] Open
Abstract
Peripartum cardiomyopathy is a type of dilated cardiomyopathy in which the exact etiology is uncertain. HELLP syndrome is characterized by a constellation of different clinical and laboratory findings, including hemolysis, elevated liver enzymes, and low platelets. Few case reports exist detailing successful diagnosis and management of postpartum HELLP syndrome, peripartum cardiomyopathy, and multisystem organ failure in a previously healthy woman. We herein report the case of a 39-year-old multiparous female with mild gestational hypertension, who presented in the third trimester with vaginal bleeding and was subsequently suspected to have intrapartum placental abruption leading to immediate Cesarean section, complicated by massive postpartum hemorrhage, necessitating care in the intensive care unit. HELLP syndrome, disseminated intravascular coagulation, and acute kidney injury requiring hemodialysis subsequently developed along with respiratory failure and peripartum cardiomyopathy. After diagnosis and proper management, the patient made a full recovery. Peripartum cardiomyopathy should remain on the differential for women with heart failure symptoms.
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Affiliation(s)
- Shany Quevedo
- Ross University School of Medicine, Miramar, FL, USA
| | - Caroline Bekele
- Wellstar Atlanta Medical Center, Family Medicine Residency Program, Atlanta, GA, USA
| | - Patrice D Thompson
- Wellstar Atlanta Medical Center, Family Medicine Residency Program, Atlanta, GA, USA
| | - Megan Philkhana
- Wellstar Atlanta Medical Center, Family Medicine Residency Program, Atlanta, GA, USA
| | - Sana Virani
- Wellstar Atlanta Medical Center, Family Medicine Residency Program, Atlanta, GA, USA
| | | | - Paul Douglass
- Wellstar Medical Group, Metro Atlanta Cardiovascular Medicine, Atlanta, GA, USA
| | - Alida M Gertz
- Wellstar Atlanta Medical Center, Family Medicine Residency Program, Atlanta, GA, USA
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7
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Byrne JJ, Seasely A, Nelson DB, Mcintire DD, Cunningham FG. Comparing acute fatty liver of pregnancy from hemolysis, elevated liver enzymes, and low platelets syndrome. J Matern Fetal Neonatal Med 2020; 35:1352-1362. [PMID: 32308076 DOI: 10.1080/14767058.2020.1754790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome are both associated with significant maternal and perinatal morbidity and mortality. Because of the overlap of several clinical and laboratory findings differentiation can sometimes be difficult. Both disorders have been of interest for more than 100 years, however they were not completely characterized until the early 1980s. It was not until the 1980s that AFLP and HELLP syndrome, and more specifically their clinical, laboratory, and pathologic findings, were further differentiated in the literature. More recently, the pathophysiologic mechanisms have been elucidated. In this review, we outline the similarities and differences in the clinical presentation, laboratory findings, maternal and perinatal outcomes, and clinical recovery for women diagnosed with these two syndromes. From our observations, we suggest that levels of fibrinogen, creatinine, cholesterol, and total bilirubin be used to assist with differentiating AFLP from HELLP syndrome upon admission in women presenting with either suspected disease. The rationale for identifying the specific conditions is that clinical consequences for recovery vary considerably. Specifically, AFLP is associated with significantly more hepatic and renal dysfunction as well as coagulopathy. Fortunately, both conditions can be managed with supportive measures with overall improved perinatal outcomes including morbidity and mortality.
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Affiliation(s)
- John J Byrne
- Department of Obstetrics and Gynecology, University of Texas, Southwestern Medical Center, Parkland Health and Hospital Systems, Dallas, TX, USA
| | - Angela Seasely
- Department of Obstetrics and Gynecology, University of Texas, Southwestern Medical Center, Parkland Health and Hospital Systems, Dallas, TX, USA
| | - David B Nelson
- Department of Obstetrics and Gynecology, University of Texas, Southwestern Medical Center, Parkland Health and Hospital Systems, Dallas, TX, USA
| | - Donald D Mcintire
- Department of Obstetrics and Gynecology, University of Texas, Southwestern Medical Center, Parkland Health and Hospital Systems, Dallas, TX, USA
| | - F Gary Cunningham
- Department of Obstetrics and Gynecology, University of Texas, Southwestern Medical Center, Parkland Health and Hospital Systems, Dallas, TX, USA
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Feldstein O, Kovo M, Tal O, Braunstein M, Grinstein E, Schreiber L, Bar J, Weiner E. The association between abnormal coagulation testing in preeclampsia, adverse pregnancy outcomes, and placental histopathology. Hypertens Pregnancy 2019; 38:176-183. [DOI: 10.1080/10641955.2019.1638396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ohad Feldstein
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
| | - Michal Kovo
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
| | - Ori Tal
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
| | - Michal Braunstein
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
| | - Ehud Grinstein
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
| | - Letizia Schreiber
- Departments of Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
| | - Eran Weiner
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
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Sagrillo-Fagundes L, Bienvenue-Pariseault J, Legembre P, Vaillancourt C. An insight into the role of the death receptor CD95 throughout pregnancy: Guardian, facilitator, or foe. Birth Defects Res 2019; 111:197-211. [PMID: 30702213 DOI: 10.1002/bdr2.1470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 01/16/2019] [Indexed: 12/24/2022]
Abstract
The prototype death receptor CD95 (Fas) and its ligand, CD95L (FasL), have been thoroughly studied due to their role in immune homeostasis and elimination of infected and transformed cells. The fact that CD95 is present in female reproductive cells and modulated during embryogenesis and pregnancy has raised interest in its role in immune tolerance to the fetoplacental unit. CD95 has been shown to be critical for proper embryonic formation and survival. Moreover, altered expression of CD95 or its ligand causes autoimmunity and has also been directly involved in recurrent pregnancy losses and pregnancy disorders. The objective of this review is to summarize studies that evaluate the mechanisms involved in the activation of CD95 to provide an updated global view of its effect on the regulation of the maternal immune system. Modulation of the CD95 system components may be the immune basis of several common pregnancy disorders.
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Affiliation(s)
- Lucas Sagrillo-Fagundes
- Department of Environmental toxicology and Chemical Pharmacology, INRS - Institut Armand-Frappier and Center for Interdisciplinary Research on Well-Being, Health, Society and Environment, Laval, Quebec, Canada
| | - Josianne Bienvenue-Pariseault
- Department of Environmental toxicology and Chemical Pharmacology, INRS - Institut Armand-Frappier and Center for Interdisciplinary Research on Well-Being, Health, Society and Environment, Laval, Quebec, Canada
| | - Patrick Legembre
- Oncogenesis, Stress & Signaling Laboratory INSERM ERL440, Centre Eugène Marquis, Inserm U1242, Equipe Ligue Contre Le Cancer, Rennes, France
| | - Cathy Vaillancourt
- Department of Environmental toxicology and Chemical Pharmacology, INRS - Institut Armand-Frappier and Center for Interdisciplinary Research on Well-Being, Health, Society and Environment, Laval, Quebec, Canada
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Abdelazim IA, AbuFaza M. Abdelazim and AbuFaza ELLP syndrome as a variant of HELLP syndrome: Case reports. J Family Med Prim Care 2019; 8:280-284. [PMID: 30911521 PMCID: PMC6396606 DOI: 10.4103/jfmpc.jfmpc_381_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: The hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome is a serious complication in pregnancy occurring in 0.5–0.9% of all pregnancies and in 10–20% of cases with severe pre-eclampsia. Previous studies described HELLP syndrome without hemolysis without any further details. Objectives: This report represents the criteria for the diagnosis of Abdelazim and AbuFaza elevated liver enzymes, low platelet count (ELLP) syndrome as a variant of HELLP syndrome. Case Reports: A 39-year-old woman, pregnant 32 weeks’ gestation, previous five cesarean sections, admitted with severe pre-eclampsia (blood pressure 160/110 mmHg, proteinuria +3, 700 mg proteins/24 h urine, and protein/creatinine ratio ≥0.9 in spot urine sample). Laboratory investigation showed elevated liver enzymes, low platelet (PLT) count, and no evidence of hemolysis. A 31-year-old woman, pregnant 33+4 weeks’ gestation, previous one cesarean section, admitted with severe pre-eclampsia (blood pressure 170/120 mmHg, proteinuria +2, 1200 mg proteins/24 h urine, and protein/creatinine ratio 1.1 in spot urine sample). Laboratory investigations showed elevated liver enzymes, low PLT count, and no evidence of hemolysis. Both patients delivered by cesarean section after stabilization of their blood pressure and dexamethasone for induction of fetal lung maturity and MgSO4 for prevention of eclampsia. Both patients had uneventful intraoperative and postoperative stay in the hospital. The liver enzymes and the PLT count were completely normal on the 5th postoperative day, and they were discharged from the hospital in good general condition. Conclusion: Abdelazim and AbuFaza ELLP syndrome is variant of HELLP syndrome without hemolysis in women with severe pre-eclampsia. Abdelazim and AbuFaza ELLP syndrome diagnostic criteria are as follows: (1) Elevated liver enzymes; (2) Low PLT count; and (3) Absence of hemolysis (normal total and unconjugated bilirubin, absence of schizocytes, and polychromatic red cells in peripheral blood smear, and normal reticulocyte count).
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Affiliation(s)
- Ibrahim A Abdelazim
- Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company, Ahmadi, Kuwait.,Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
| | - Mohannad AbuFaza
- Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company, Ahmadi, Kuwait
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Orabona R, Vizzardi E, Sciatti E, Prefumo F, Bonadei I, Valcamonico A, Metra M, Frusca T. Maternal cardiac function after HELLP syndrome: an echocardiography study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:507-513. [PMID: 28971558 DOI: 10.1002/uog.17358] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 10/27/2016] [Accepted: 11/03/2016] [Indexed: 06/07/2023]
Abstract
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). Diastolic filling (E/A and E/E' ratios) and tissue Doppler imaging were evaluated for both ventricles and the myocardial performance index was calculated. RESULTS Only women with previous HELLP syndrome showed significant LV concentric hypertrophy (20.4%). However, in both HELLP and PE groups, LV concentric remodeling (46.9% and 46.7%, respectively), diastolic dysfunction (expressed as altered E/A and E/E' ratios) and reduced LVEF (14.3% and 21.7%, respectively) were documented. RV variables did not differ significantly between cases and controls, except for FAC and E/E' ratio, which were slightly impaired in women with previous HELLP syndrome compared to those with previous PE (16.3% vs 10.0%, P = 0.04; 14.3% vs 3.3%, P = 0.03, respectively). CONCLUSIONS The significant overlap of echocardiographic features in women with previous PE and HELLP syndrome suggests that these two conditions share the same pathophysiology. However, HELLP syndrome may lead to more severe cardiovascular remodeling in the short to medium term after delivery. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Orabona
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - E Vizzardi
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - E Sciatti
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - F Prefumo
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - I Bonadei
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - A Valcamonico
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - M Metra
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - T Frusca
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
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Maternal serum placental growth factor and pregnancy-associated plasma protein A measured in the first trimester as parameters of subsequent pre-eclampsia and small-for-gestational-age infants: A prospective observational study. Obstet Gynecol Sci 2017; 60:154-162. [PMID: 28344956 PMCID: PMC5364097 DOI: 10.5468/ogs.2017.60.2.154] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/04/2016] [Accepted: 10/04/2016] [Indexed: 12/30/2022] Open
Abstract
Objective To examine the first-trimester maternal serum placental growth factor (PlGF) and pregnancy-associated plasma protein A (PAPP-A) levels in pregnancies associated with pre-eclampsia (PE) or small-for-gestational-age (SGA) infants, and determine the predictive accuracy of PlGF and of PAPP-A for either PE or SGA infants. Methods This prospective, observational study included 175 pregnant women, and of these women, due to participant withdrawal or loss to follow-up, delivery data were collected from the medical records of 155 women, including 4 who had twin pregnancies. The women's maternal history was recorded, and the PlGF and PAPP-A levels at 11 to 13 gestational weeks were measured. During the second trimester, the maternal uterine artery's systolic/diastolic ratio was measured. Multiples of the median (MoM) of PlGF and PAPP-A were determined, and the associations of these values with the risk factors of SGA and PE were evaluated. Logistic regression analysis was used to determine whether PlGF and PAPP-A are useful markers for predicting SGA infants. Results The PAPP-A MoM level was significantly lower in women with advanced maternal age, multipara women, and women with gestational diabetes than in their counterparts. The PlGF and PAPP-A MoM levels were higher in women with a twin pregnancy than in those with a singleton pregnancy. There was a significant relationship between the maternal serum PAPP-A MoM level in the first trimester and the uterine artery systolic/diastolic ratio in the second trimester. Results of logistic regression analysis showed that low PlGF and PAPP-A MoM levels were predictors of SGA infants (odds ratio, 0.143; 95% confidence interval, 0.025 to 0.806; odds ratio, 0.191; 95% confidence interval, 0.051 to 0.718, respectively). Conclusion PlGF and PAPP-A are potentially useful as first-trimester markers for SGA infants and some hypertensive disorders of pregnancy.
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The placental component and obstetric outcome in severe preeclampsia with and without HELLP syndrome. Placenta 2016; 47:99-104. [DOI: 10.1016/j.placenta.2016.09.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/15/2016] [Accepted: 09/22/2016] [Indexed: 11/21/2022]
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Atiba AS, Abbiyesuku FM, Oparinde DP, 'Niran-Atiba TA, Akindele RA. Plasma Malondialdehyde (MDA): An Indication of Liver Damage in Women with Pre-Eclamsia. Ethiop J Health Sci 2016; 26:479-486. [PMID: 28446854 PMCID: PMC5389063 DOI: 10.4314/ejhs.v26i5.10] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND One of the features associated with pre-eclampsia is elevated liver transaminases. The reason this happens has not been fully described. However, the hepatocytes are not known to be spared by free radical injury. This study was conducted to examine the relationship between product of free radical injury (malondialdehyde) and transaminases in pre-eclamptic women. PATIENTS AND METHODS A total of 98 and 115 pre-eclamptic and apparently normal pregnant women were selected from the booking clinic of Ladoke Akintola University of Technology Teaching Hospital, Osogbo. Non-pregnant women were selected from volunteered members of staff. Malondialdehyde (MDA), aspartate transaminase (AST) and alanine transaminase (ALT) analyses were determined on collected venous blood sample. Statistical analyses of variables were done using SPSS 17 taking level of significance to be p<0.05. RESULTS Subjects with plasma AST between 10 and 20U/L had mean plasma MDA of 0.92µmol/l whereas those with plasma levels greater than 41U/L had mean plasma MDA of 4.72µmol/l. Similarly, Subjects with plasma ALT between 10 and 20U/L had mean plasma MDA of 0.86µmol/l, and subjects with plasma ALT greater than 51 U/L had mean plasma MDA of 4.71µmol/l. Positive correlation was observed between AST and ALT(r=0.79; p=0.047), between AST and MDA(r=0.690; p=0.061) as well as between ALT and MDA(r=0.571; p=0.049). CONCLUSION The elevated liver enzymes seen in women with pre-eclampsia may be due to free radical injury to the liver. Pre-eclamptic women without free radical injury did not have elevated transaminases.
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Affiliation(s)
- Adeniran S Atiba
- Department of Chemical Pathology, Ekiti State University, Ado-Ekiti, Nigeria
| | | | - Dolapo P Oparinde
- Department of Chemical Pathology, Ladoke Akintola University of Technology Teaching Hospital, Nigeria
| | | | - Rasaq A Akindele
- Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology Teaching Hospital, Nigeria
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Khan R, Maduray K, Moodley J, Naicker T. Activation of CD35 and CD55 in HIV associated normal and pre-eclamptic pregnant women. Eur J Obstet Gynecol Reprod Biol 2016; 204:51-6. [PMID: 27521598 DOI: 10.1016/j.ejogrb.2016.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 06/01/2016] [Accepted: 06/11/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The delicate balance which exists between complement activation and its regulation is altered in HIV infection and pregnancy disorders such as pre-eclampsia. Therefore, the purpose of this study was to investigate the expression of complement regulatory (Creg) proteins (CD35 and CD55) in HIV associated normal and pre-eclamptic pregnancies. STUDY DESIGN The total study population (n=100) consisted of normotensive pregnant (n=50) and pre-eclamptic (n=50) women. These groups were equally sub-stratified into HIV infected and uninfected groups (n=25 per group). Standard haematological tests were conducted. Flow cytometric analysis of isolated neutrophils were performed using fluorescein isothiocyanate-conjugated anti-CD35 and phycoerythrin-cyanine 5 conjugated anti-CD55. RESULTS HELLP syndrome characteristics of increased lactate dehydrogenase enzymes levels, low platelet counts, cell morphological abnormalities (red cell fragmentation) and anaemia were observed in 40% of the HIV infected pre-eclamptic group. Red cell fragmentation inclusive of burr cells and schistocytes were also noted. Activated partial thromboplastin time and fibrinogen differed significantly between the HIV uninfected pre-eclamptic compared to the HIV infected pre-eclamptic groups (p<0.01). Irrespective of HIV status, the mean fluorescence intensity of CD35 and CD55 were significantly higher in the pre-eclamptic compared to the normotensive pregnant (p=0.0001; p=0.0001 respectively) groups. In the pre-eclamptic groups, the expression of both CD35 and CD55 did not significantly differ between HIV infected and uninfected women (p=0.486; p=0.767 respectively). CONCLUSIONS This study demonstrates an up-regulation of complement regulatory proteins, CD35 and CD55 in HIV associated pre-eclamptic compared to normotensive pregnancy. This elevation of the Creg proteins is an adaptive immune response to the high complement-mediated cell lysis that occurs in HIV infection and further aggravated by the complement activated state of pre-eclampsia.
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Affiliation(s)
- R Khan
- Optics and Imaging Centre, University of KwaZulu-Natal, South Africa.
| | - K Maduray
- Optics and Imaging Centre, University of KwaZulu-Natal, South Africa
| | - J Moodley
- Womens' Health and HIV Research Group, University of KwaZulu-Natal, South Africa
| | - T Naicker
- Optics and Imaging Centre, University of KwaZulu-Natal, South Africa.
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Rahgozar S, Amirian T, Qi M, Shahshahan Z, Entezar-E-Ghaem M, Ghasemi Tehrani H, Miroliaei M, Krilis SA, Giannakopoulos B. Improved Assay for Quantifying a Redox Form of Angiotensinogen as a Biomarker for Pre-Eclampsia: A Case-Control Study. PLoS One 2015; 10:e0135905. [PMID: 26312482 PMCID: PMC4552422 DOI: 10.1371/journal.pone.0135905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/28/2015] [Indexed: 01/13/2023] Open
Abstract
Objective Angiotensinogen exists in two distinct redox forms in plasma, the oxidized sulfhydryl-bridge form and the reduced, unbridged, free thiol form. The oxidized form of angiotensinogen compared to the free thiol form preferentially interacts with renin resulting in increased generation of angiotensin. The predictive potential of the ratio of free-thiol to oxidized angiotensinogen in the plasma for pre-eclampsia was first suggested by the Read group in ref 10. We propose an improved method for determining the ratio and validate the method in a larger cohort of pregnant women. Methods Plasma samples from 115 individuals with pre-eclampsia and from 55 healthy pregnant control subjects were collected sequentially over a 2 year period. Using two distinct enzyme-linked immunosorbent assays (ELISAs) the plasma levels of total and free thiol angiotensinogen were quantified. The oxidized angiotensinogen plasma level is derived by subtracting the level of free thiol, reduced angiotensinogen from the total angiotensinogen levels in the plasma. Results The relative proportion of free thiol angiotensinogen, expressed as a percentage of that observed with an in-house standard, is significantly decreased in pre-eclamptic patients (70.85% ± 29.49%) (mean ± SD) as compared to healthy pregnant controls (92.98 ± 24.93%) (mean ± SD) p ≤ 0.0001. The levels of total angiotensinogen did not differ between the two groups. Conclusion Patients with pre-eclampsia had substantially lower levels of free thiol angiotensinogen compared to healthy pregnant controls, whilst maintaining similar total angiotensinogen levels in the plasma. Hence, elevated levels of plasma oxidized angiotensinogen may be a contributing factor to hypertension in the setting of pre-eclampsia.
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Affiliation(s)
- Soheila Rahgozar
- Department of Biology, Faculty of Science, University of Isfahan, Isfahan, Iran
| | - Tayebeh Amirian
- Department of Biology, Faculty of Science, University of Isfahan, Isfahan, Iran
| | - Miao Qi
- Department of Infectious Diseases, Immunology and Sexual Health and Department of Medicine, St George Hospital, University of New South Wales, Sydney, Australia
| | - Zahra Shahshahan
- Department of Obstetrics and Gynaecology, Shahid Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Hatav Ghasemi Tehrani
- Department of Obstetrics and Gynaecology, Shahid Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehran Miroliaei
- Department of Biology, Faculty of Science, University of Isfahan, Isfahan, Iran
| | - Steven A. Krilis
- Department of Infectious Diseases, Immunology and Sexual Health and Department of Medicine, St George Hospital, University of New South Wales, Sydney, Australia
| | - Bill Giannakopoulos
- Department of Infectious Diseases, Immunology and Sexual Health and Department of Medicine, St George Hospital, University of New South Wales, Sydney, Australia
- * E-mail:
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Roomaney R, Andipatin MG, Naidoo A. The psychological experience of women who survived HELLP syndrome in Cape Town, South Africa. Health SA 2014. [DOI: 10.4102/hsag.v19i1.762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Haemolysis, elevated liver enzymes and low platelet count (HELLP syndrome) is a high-risk pregnancy condition that could be fatal to mother and/or baby. It is characterised, as the acronym indicates, by haemolysis, elevated liver enzymes and low blood platelets. Objective: This study explored women in Cape Town’s psychological experience of HELLP syndrome.Method: Six participants who previously experienced HELLP syndrome were interviewed. Using a grounded theory approach, themes emerged and a model illlustrating the psychological experience of HELLP syndrome was constructed.Results: The major themes that emerged were the perceived lack of information, a need to assign blame and a shift in focus. Themes of not knowing and trance and/or surreal experience underpin the cognitive aspects of the HELLP syndrome experience. Themes that expressed feelings of an inability to control, whirlwind and/or rapid pace and support acted together to bind the experience. Finally, emotions such as anger, ambivalence, disbelief, anxiety, guilt, loneliness and fear were present throughout the experience.Conclusion: This study developed an initial exploratory model representing the psychological experience of HELLP syndrome in a sample of South African women. Underlying this entire experience was a perceived lack of information which had a profound effect on numerous aspects of the experience ranging from where to locate blame to the varied emotions experienced. Agtergrond: Die HELLP sindroom is ‘n hoë-risiko swangerskap toestand wat kan dodelik vir moeder en/of baba wees. Dit word gekenmerk deur hemolise, verhoogde lewerensieme en lae bloedplaatjies.Doelwit: Hierdie studie het Suid-Afrikaanse vroue se sielkundige ervaring van die HELLP sindroom ondersoek.Metode: Ses deelnemers wat voorheen HELLP sindroom ervaar het is ondervra. Met die gebuik van gefundeerde teorie as ‘n teoretiese raamwerk en ontleding het temas na vore gekom en ‘n model wat die sielkundige ervaring van HELLP sindroom illustreer, is gebou.Resultate: Die vernaamste temas wat na vore gekom het was die oënskynlike gebrek aan inligting, ‘n behoefte om skuld toe te skryf en ‘n verskuiwing in fokus. Die tema van nie weet en beswyming en/of surrealistiese ervaring ondersteun die kognitiewe aspekte van die HELLP sindroom. Temas wat gevoelens van geen beheer, warrelwind en/of vinnige tempo en ondersteuning uitgesprek het, het saam opgetree om die ervaring te bind. Ten slotte, emosies soos woede, teenstrydigheid, ongeloof, angs, skuldgevoelens, eensaamheid en vrees was teenwoordig in die hele ervaring.Gevolgtrekking: Hierdie studie het van’n aanvanklike ondersoekende model van die sielkundige ervaring van HELLP sindroom tot ‘n steekproef van die Suid-Afrikaanse vroue ontwikkel. Onderliggend aan hierdie hele ervaring was ‘n oënskynlike gebrek aan inligting wat ‘n diepgaande uitwerking gehad het op talle aspekte van die ervaring wat gewissel het van waar om die blaam te plaas tot die uiteenlopende ervaarde emosies.
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HELLP or Help: A Real Challenge. J Obstet Gynaecol India 2014; 65:172-5. [PMID: 26085738 DOI: 10.1007/s13224-014-0582-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 06/16/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To ascertain the prevalence, presentation, diagnosis, severity, and complications of HELLP syndrome. MATERIALS AND METHODS This is a prospective observational study analyzing the conditions and the data of 24 cases of HELLP syndrome in a tertiary care hospital. The analysis was done for the demographic characteristics, presentation of these patients, complications associated, and the perinatal outcome. RESULTS 0.45 % of the patients admitted for delivery developed HELLP syndrome. Majority of the patients developed the condition in 30-36 weeks period of gestation, while five patients developed it in the postpartum period. The condition led to 12.5 % of maternal and 45.8 % of perinatal mortality. CONCLUSION HELLP syndrome is an important cause for maternal and perinatal morbidity and mortality.
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Aydin S, Ersan F, Ark C, Arıoğlu Aydın Ç. Partial HELLP syndrome: Maternal, perinatal, subsequent pregnancy and long-term maternal outcomes. J Obstet Gynaecol Res 2014; 40:932-40. [DOI: 10.1111/jog.12295] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 09/06/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Serdar Aydin
- Obstetrics and Gynaecology; Istanbul Kanuni Sultan Suleyman Research and Teaching Hospital; İstanbul Turkey
| | - Fırat Ersan
- Obstetrics and Gynaecology; Istanbul Kanuni Sultan Suleyman Research and Teaching Hospital; İstanbul Turkey
| | - Cemal Ark
- Obstetrics and Gynaecology; Istanbul Kanuni Sultan Suleyman Research and Teaching Hospital; İstanbul Turkey
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The combined association of psychosocial stress and chronic hypertension with preeclampsia. Am J Obstet Gynecol 2013; 209:438.e1-438.e12. [PMID: 23850528 DOI: 10.1016/j.ajog.2013.07.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/25/2013] [Accepted: 07/01/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study aims to evaluate perceived lifetime stress, perceived stress during pregnancy, chronic hypertension, and their joint association with preeclampsia risk. STUDY DESIGN This study includes 4314 women who delivered a singleton live birth at the Boston Medical Center from October 1998 through February 2008. Chronic hypertension was defined as hypertension diagnosed before pregnancy. Information regarding lifetime stress and perceived stress during pregnancy was collected by questionnaire. Preeclampsia was diagnosed by clinical criteria. RESULTS Lifetime stress (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.6-2.9), perceived stress during pregnancy (OR, 1.7; 95% CI, 1.3-2.2), and chronic hypertension (OR, 10.4; 95% CI, 7.5-14.4) were each associated with an increased risk of preeclampsia. Compared to normotensive pregnancy with low lifetime stress, both normotensive pregnancy with high lifetime stress (OR, 2.1; 95% CI, 1.6-2.9) and pregnancy with chronic hypertension and low lifetime stress (OR, 10.2; 95% CI, 7.0-14.9) showed an increased risk of preeclampsia, while pregnancy with high lifetime stress and chronic hypertension yielded the highest risk of preeclampsia (OR, 21.3; 95% CI, 10.2-44.3). The joint association of perceived stress during pregnancy and chronic hypertension with preeclampsia was very similar to that of the joint association of lifetime stress and chronic hypertension with preeclampsia. CONCLUSION This finding indicates that high psychosocial stress and chronic hypertension can act in combination to increase the risk of preeclampsia up to 20-fold. This finding underscores the importance of efforts to prevent, screen, and manage chronic hypertension, along with those to reduce psychosocial stress, particularly among women with chronic hypertension.
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John K, Wielgosz S, Schulze-Osthoff K, Bantel H, Hass R. Increased plasma levels of CK-18 as potential cell death biomarker in patients with HELLP syndrome. Cell Death Dis 2013; 4:e886. [PMID: 24157880 PMCID: PMC3920953 DOI: 10.1038/cddis.2013.408] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 09/14/2013] [Accepted: 09/16/2013] [Indexed: 11/15/2022]
Abstract
HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome represents a life-threatening pregnancy disorder with high fetal and maternal mortality, but its underlying molecular mechanisms remain unknown. Although apoptosis has been implicated in HELLP syndrome, its pathogenic role remains largely unclear. In the present study, we investigated whether the detection of apoptosis by novel plasma biomarkers is of diagnostic value in HELLP patients. For this purpose, we analyzed two biomarkers that specifically detect apoptosis or overall cell death of epithelial cells, such as hepatocytes or placental trophoblasts, through the release of caspase-cleaved or total (caspase-cleaved and uncleaved) cytokeratin-18 (CK-18) in plasma of HELLP patients compared with pregnant as well as non-pregnant healthy women. In addition, caspase activation and cell death were determined in placental tissues of HELLP patients and individuals with normal pregnancy. In contrast to pregnant or non-pregnant healthy controls, we observed significantly increased levels of both caspase-cleaved and total CK-18 in plasma of HELLP patients. Following delivery, CK-18 levels rapidly decreased in HELLP patients. Caspase activation and cell death were also elevated in placental tissues from HELLP patients compared with healthy pregnant women. These data demonstrate not only that apoptosis is increased in HELLP syndrome, but also that caspase-cleaved or total CK-18 are promising plasma biomarkers to identify patients with HELLP syndrome. Thus, further studies are warranted to evaluate the utility of these biomarkers for monitoring disease activity in HELLP syndrome.
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Affiliation(s)
- K John
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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Gioffrè G, Bodkin PA, Labram EK, Shetty A. Beware of delayed severe brain swelling after intracerebral haematoma in HELLP syndrome. Obstet Med 2013; 6:129-131. [PMID: 27708705 DOI: 10.1258/om.2012.110030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is a condition associated with increased risk of adverse outcomes during pregnancy and peripartum, including neurological complications. We report the third case in the world literature of delayed brain swelling following cerebral haemorrhage as a complication of HELLP syndrome. A 36-year-old woman in labour developed HELLP, which was complicated with intracerebral haematoma. This was evacuated, but motor impairment persisted after surgery and unfortunately the patient died unexpectedly during the 11th postoperative day. Computer tomographic brain scans documented diffuse cerebral swelling, which we think may have been caused by cerebral vasospasm. Cerebral vasospasm should always be considered when managing patients who suffered from stroke complicating HELLP syndrome. Close monitoring is advised even in later stages of recovery.
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Affiliation(s)
- G Gioffrè
- Department of Neurosurgery, Aberdeen Royal Infirmary
| | - P A Bodkin
- Department of Neurosurgery, Aberdeen Royal Infirmary
| | - E K Labram
- Department of Neurosurgery, Aberdeen Royal Infirmary
| | - A Shetty
- Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital , Aberdeen , UK
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Tayal D, Goswami B, Patra SK, Tripathi R, Khaneja A. Association of inflammatory cytokines, lipid peroxidation end products and nitric oxide with the clinical severity and fetal outcome in preeclampsia in Indian women. Indian J Clin Biochem 2013; 29:139-44. [PMID: 24757293 DOI: 10.1007/s12291-013-0320-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 03/24/2013] [Indexed: 11/25/2022]
Abstract
Preeclampsia is a multisystem disorder associated with maternal hypertension, placental abnormalities and adverse fetal outcomes. The various pathways involved in its etiology include endothelial dysfunction, inflammatory milieu, lipid peroxidation and immunological imbalance. The present study was conducted to evaluate the causative and predictive role of nitric oxide, lipid peroxidation end products (MDA) and inflammatory cytokines (IL-6, TNF-α) in clinical presentation, severity and fetal outcome in preeclampsia. The study population was divided into 3 groups- Non- pregnant females comprising the control population; G1 and G2 groups included normal pregnant and pregnant females with preeclampsia with 50 patients in each group. Nitric Oxide and MDA levels were found to be highest in the preeclamptic patients as compared to other two groups. ROC curve analysis shows the superiority of the inflammatory markers as determinants of severity of preeclampsia which suggests the emerging role of pro inflammatory markers in the various pathological changes in preeclampsia. TNF-α emerged as the best marker in multivariate analysis and thus, has the potential for being used as a marker for PIH. Our study illustrates the multifactorial etiology of preeclampsia involving oxidative stress, proinflammatory milieu and endothelial dysfunction.
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Affiliation(s)
- Devika Tayal
- Department of Biochemistry, Lala Ram Swaroop Institute, New Delhi, India
| | - Binita Goswami
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India
| | - S K Patra
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India
| | - Reva Tripathi
- Department of Obstetrics & Gynaecology, Maulana Azad Medical College & Associated LN Hospital, New Delhi, India
| | - Alka Khaneja
- Department of Biochemistry, Maulana Azad Medical College & Associated LN Hospital, New Delhi, India
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Shaikh N, Ummunissa F, Shafak Mustafa G. HELLP Needs Aggressive Help. Qatar Med J 2011. [DOI: 10.5339/qmj.2011.2.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
HELLP (Hemolysis Elevated Liver Enzymes and Low Platelets) syndrome is a multi-system pregnancy associated disorder, commonly seen in patients with pre-eclampsia but can occur alone. It is significantly associated with maternal-fetal morbidity and mortality.
A triad of hemolysis elevated liver enzymes and thrombocytopenia after 24 weeks of gestation is diagnostic of this syndrome. HELLP syndrome is classified depending on simple parameters but it dictates severity of the disease. Frequently encountered complications with HELLP syndrome are hemorrhagic stroke, disseminated intravascular coagulation, pulmonary edema, acute renal failure and hepatic rapture. The aggressive supportive care of failing organs with high dose of steroids will decrease the duration of HELLP syndrome, decreases intensive care and hospital stay of these patients as well as reduction in fetal complications. HELLP syndrome is associated with significant increase in morbidity and mortality of pregnant patients; hence it is of vital importance that not only obstetrician, but acute care physicians and intensivist should be aware of this clinical entity. We report a case of Classl, normotensive postpartum HELLP syndrome complicated by pulmonary edema and acute renal failure, successfully managed in our intensive care unit.
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Affiliation(s)
- N. Shaikh
- Department of Anesthesia and Intensive Care Unit (ICU), Hamad Medical Corporation, Doha, Qatar
| | - F. Ummunissa
- Department of Anesthesia and Intensive Care Unit (ICU), Hamad Medical Corporation, Doha, Qatar
| | - G. Shafak Mustafa
- Department of Anesthesia and Intensive Care Unit (ICU), Hamad Medical Corporation, Doha, Qatar
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Mehrabian F, Mohammadizadeh F, Moghtaderi N, Najafian A. Comparison of placental pathology between severe preeclampsia and HELLP syndrome. Arch Gynecol Obstet 2011; 285:175-81. [DOI: 10.1007/s00404-011-1948-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 06/03/2011] [Indexed: 10/18/2022]
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Prusac IK, Zekic Tomas S, Roje D. Apoptosis, proliferation and Fas ligand expression in placental trophoblast from pregnancies complicated by HELLP syndrome or pre-eclampsia. Acta Obstet Gynecol Scand 2011; 90:1157-63. [PMID: 21501125 DOI: 10.1111/j.1600-0412.2011.01152.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate apoptosis, proliferation and Fas ligand expression of placental trophoblast in the hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome and in pre-eclampsia (PE), and to compare this with normal pregnancies. DESIGN Prospective study. SETTING University hospital in Croatia. SAMPLE Placentae from women with HELLP syndrome (n=10), PE (n=10) and normal pregnancies (n=10). METHODS The HELLP syndrome was diagnosed with platelets <100×10(9) /L, aspartate aminotransferase (AST) and alanine transaminase (ALT) >70 U/L and lactic acid dehydrogenase (LDH) > 600 U/L. Pre-eclampsia was diagnosed at blood pressure >140/90 mmHg, with proteinuria >300 mg/L/24 hours. For detection of apoptosis and proliferation in villous trophoblast, antibodies M30 and Ki-67 were used. Expression of Fas ligand was assessed using immunohistochemistry and the semiquantitative HSCORE method. MAIN OUTCOME MEASURES Apoptosis, proliferation and Fas ligand expression in villous trophoblast. RESULTS Apoptosis, proliferation and Fas ligand expression were higher in villous trophoblast in HELLP syndrome than in the PE group (p=0.015, p=0.018 and p=0.002, respectively) and the control group (p=0.000, p=0.012 and p=0.049, respectively). Placentae from the PE group had higher levels of apoptosis (p=0.019), lower Fas ligand expression (p=0.029) and no difference in proliferation (p=0.887) compared with the control group. CONCLUSIONS There is an increase in apoptosis, proliferation and Fas ligand expression in placentae from women with HELLP syndrome compared with placentae from PE and normal pregnancies. Our findings indicate the possibility of differential mechanisms behind HELLP syndrome and PE.
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Affiliation(s)
- Ivana Kuzmic Prusac
- Department of Pathology, Forensic Medicine and Cytology, Clinical Hospital Centre Split, Spinciceva 1, Split, Croatia.
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27
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Zavalza-Gómez AB. Obesity and oxidative stress: a direct link to preeclampsia? Arch Gynecol Obstet 2010; 283:415-22. [DOI: 10.1007/s00404-010-1753-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 10/29/2010] [Indexed: 10/18/2022]
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Cowans NJ, Stamatopoulou A, Matwejew E, von Kaisenberg CS, Spencer K. First-trimester placental growth factor as a marker for hypertensive disorders and SGA. Prenat Diagn 2010; 30:565-70. [DOI: 10.1002/pd.2525] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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29
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Molvarec A, Tamási L, Losonczy G, Madách K, Prohászka Z, Rigó J. Circulating heat shock protein 70 (HSPA1A) in normal and pathological pregnancies. Cell Stress Chaperones 2010; 15:237-47. [PMID: 19821156 PMCID: PMC2866993 DOI: 10.1007/s12192-009-0146-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Revised: 09/22/2009] [Accepted: 09/29/2009] [Indexed: 10/20/2022] Open
Abstract
Heat shock proteins (Hsps) are ubiquitous and phylogenetically conserved molecules. They are usually considered to be intracellular proteins with molecular chaperone and cytoprotective functions. However, Hsp70 (HSPA1A) is present in the peripheral circulation of healthy nonpregnant and pregnant individuals. In normal pregnancy, circulating Hsp70 levels are decreased, and show a positive correlation with gestational age and an inverse correlation with maternal age. The capacity of extracellular Hsp70 to elicit innate and adaptive proinflammatory (Th1-type) immune responses might be harmful in pregnancy and may lead to the maternal immune rejection of the fetus. Decreased circulating Hsp70 level, consequently, may promote the maintenance of immunological tolerance to the fetus. Indeed, elevated circulating Hsp70 concentrations are associated with an increased risk of several pregnancy complications. Elevated Hsp70 levels in healthy pregnant women at term might also have an effect on the onset of labor. In preeclampsia, serum Hsp70 levels are increased, and reflect systemic inflammation, oxidative stress and hepatocellular injury. Furthermore, serum Hsp70 levels are significantly higher in patients with the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome) than in severely preeclamptic patients without HELLP syndrome. In HELLP syndrome, elevated serum Hsp70 level indicates tissue damage (hemolysis and hepatocellular injury) and disease severity. Increased circulating Hsp70 level may not only be a marker of these conditions, but might also play a role in their pathogenesis. Extracellular Hsp70 derived from stressed and damaged, necrotic cells can elicit a proinflammatory (Th1) immune response, which might be involved in the development of the maternal systemic inflammatory response and resultant endothelial damage in preeclampsia and HELLP syndrome. Circulating Hsp70 level is also elevated in preterm delivery high-risk patients, particularly in treatment-resistant cases, and may be a useful marker for evaluating the curative effects of treatment for preterm delivery. In addition, increased circulating Hsp70 levels observed in asthmatic pregnant patients might play a connecting role in the pathomechanism of asthmatic inflammation and obstetrical/perinatal complications. Nevertheless, a prospective study should be undertaken to determine whether elevated serum Hsp70 level precedes the development of any pregnancy complication, and thus can help to predict adverse maternal or perinatal pregnancy outcome. Moreover, the role of circulating Hsp70 in normal and pathological pregnancies is not fully known, and further studies are warranted to address this important issue.
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Affiliation(s)
- Attila Molvarec
- First Department of Obstetrics and Gynecology, Semmelweis University, Baross utca 27, Budapest, 1088, Hungary.
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30
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Nasr A, Nafeh H. Decreased hepatic perfusion in patients with HELLP syndrome. J OBSTET GYNAECOL 2009; 29:624-7. [DOI: 10.1080/01443610903061728] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Smulian J, Shen-Schwarz S, Scorza W, Kinzler W, Vintzileos A. A clinicohistopathologic comparison between HELLP syndrome and severe preeclampsia. J Matern Fetal Neonatal Med 2009. [DOI: 10.1080/jmf.16.5.287.293] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- John Smulian
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School/Robert Wood Johnson University Hospital New Brunswick New Jersey USA
| | - Susan Shen-Schwarz
- Department of Pathology University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School/Saint Peter's University Hospital New Brunswick New Jersey USA
| | - William Scorza
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School/Robert Wood Johnson University Hospital New Brunswick New Jersey USA
| | - Wendy Kinzler
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School/Robert Wood Johnson University Hospital New Brunswick New Jersey USA
| | - Anthony Vintzileos
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School/Robert Wood Johnson University Hospital New Brunswick New Jersey USA
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32
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Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: clinical issues and management. A Review. BMC Pregnancy Childbirth 2009; 9:8. [PMID: 19245695 PMCID: PMC2654858 DOI: 10.1186/1471-2393-9-8] [Citation(s) in RCA: 286] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 02/26/2009] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10-20% of cases with severe preeclampsia. The present review highlights occurrence, diagnosis, complications, surveillance, corticosteroid treatment, mode of delivery and risk of recurrence. METHODS Clinical reports and reviews published between 2000 and 2008 were screened using Pub Med and Cochrane databases. RESULTS AND CONCLUSION About 70% of the cases develop before delivery, the majority between the 27th and 37th gestational weeks; the remainder within 48 hours after delivery. The HELLP syndrome may be complete or incomplete. In the Tennessee Classification System diagnostic criteria for HELLP are haemolysis with increased LDH (> 600 U/L), AST (>or= 70 U/L), and platelets < 100 x 10(9)/L. The Mississippi Triple-class HELLP System further classifies the disorder by the nadir platelet counts. The syndrome is a progressive condition and serious complications are frequent. Conservative treatment (>or= 48 hours) is controversial but may be considered in selected cases < 34 weeks' gestation. Delivery is indicated if the HELLP syndrome occurs after the 34th gestational week or the foetal and/or maternal conditions deteriorate. Vaginal delivery is preferable. If the cervix is unfavourable, it is reasonable to induce cervical ripening and then labour. In gestational ages between 24 and 34 weeks most authors prefer a single course of corticosteroid therapy for foetal lung maturation, either 2 doses of 12 mg betamethasone 24 hours apart or 6 mg or dexamethasone 12 hours apart before delivery. Standard corticosteroid treatment is, however, of uncertain clinical value in the maternal HELLP syndrome. High-dose treatment and repeated doses should be avoided for fear of long-term adverse effects on the foetal brain. Before 34 weeks' gestation, delivery should be performed if the maternal condition worsens or signs of intrauterine foetal distress occur. Blood pressure should be kept below 155/105 mmHg. Close surveillance of the mother should be continued for at least 48 hours after delivery.
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Affiliation(s)
- Kjell Haram
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway.
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Vinnars MT, Wijnaendts LC, Westgren M, Bolte AC, Papadogiannakis N, Nasiell J. Severe Preeclampsia With and Without HELLP Differ With Regard to Placental Pathology. Hypertension 2008; 51:1295-9. [DOI: 10.1161/hypertensionaha.107.104844] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the present study was to evaluate the histopathology in placentas from patients with severe preeclampsia with and without hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. An additional aim was to compare the prevalence of infants born small for gestational age in the 2 groups. The study is retrospective and includes 178 women who have been diagnosed at the Karolinska University Hospital Huddinge or at the Free University Medical Center between 2000 and 2005 with severe preeclampsia. A total of 96 women had severe preeclampsia without signs of HELLP (preeclampsia group), whereas 82 fulfilled the criteria for having HELLP syndrome (HELLP group). Infarction (
P
=0.014), intervillous thrombosis (
P
<0.001), and abruption (
P
=0.002) were more common in the preeclampsia group than in the HELLP group. There was no statistically significant difference in the frequency of accelerated villous maturation (
P
=0.61), decidual arteriopathy (
P
=0.27), or chorioamnionitis (
P
=0.61). Furthermore, there was a higher mean placental weight, adjusted for gestational age, in the Swedish HELLP material than in the preeclampsia group (
P
<0.001). Finally, mothers in the preeclampsia group gave birth significantly more often to small for gestational age babies than mothers suffering from HELLP syndrome (
P
<0.001). The histopathologic profile and the range of placental lesions were partly different in the preeclampsia and HELLP patients. Considering the central role that placenta seems to have in preeclampsia, the present result might suggest that different underlying pathogenetic mechanisms and courses can be in play in patients with preeclampsia and HELLP syndrome.
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Affiliation(s)
- Marie-Therese Vinnars
- From the Department of Laboratory Medicine, Division of Pathology (M.-T.V., N.P.) and Department of Obstetrics and Gynecology, CLINTEC (M.-T.V., M.W., J.N.), Karolinska Institutet, Stockholm, Sweden; and the Departments of Pathology (L.C.D.W.) and Obstetrics and Gynaecology (A.C.D.), Free University Medical Center, Amsterdam, The Netherlands
| | - Liliane C.D. Wijnaendts
- From the Department of Laboratory Medicine, Division of Pathology (M.-T.V., N.P.) and Department of Obstetrics and Gynecology, CLINTEC (M.-T.V., M.W., J.N.), Karolinska Institutet, Stockholm, Sweden; and the Departments of Pathology (L.C.D.W.) and Obstetrics and Gynaecology (A.C.D.), Free University Medical Center, Amsterdam, The Netherlands
| | - Magnus Westgren
- From the Department of Laboratory Medicine, Division of Pathology (M.-T.V., N.P.) and Department of Obstetrics and Gynecology, CLINTEC (M.-T.V., M.W., J.N.), Karolinska Institutet, Stockholm, Sweden; and the Departments of Pathology (L.C.D.W.) and Obstetrics and Gynaecology (A.C.D.), Free University Medical Center, Amsterdam, The Netherlands
| | - Annemieke C. Bolte
- From the Department of Laboratory Medicine, Division of Pathology (M.-T.V., N.P.) and Department of Obstetrics and Gynecology, CLINTEC (M.-T.V., M.W., J.N.), Karolinska Institutet, Stockholm, Sweden; and the Departments of Pathology (L.C.D.W.) and Obstetrics and Gynaecology (A.C.D.), Free University Medical Center, Amsterdam, The Netherlands
| | - Nikos Papadogiannakis
- From the Department of Laboratory Medicine, Division of Pathology (M.-T.V., N.P.) and Department of Obstetrics and Gynecology, CLINTEC (M.-T.V., M.W., J.N.), Karolinska Institutet, Stockholm, Sweden; and the Departments of Pathology (L.C.D.W.) and Obstetrics and Gynaecology (A.C.D.), Free University Medical Center, Amsterdam, The Netherlands
| | - Josefine Nasiell
- From the Department of Laboratory Medicine, Division of Pathology (M.-T.V., N.P.) and Department of Obstetrics and Gynecology, CLINTEC (M.-T.V., M.W., J.N.), Karolinska Institutet, Stockholm, Sweden; and the Departments of Pathology (L.C.D.W.) and Obstetrics and Gynaecology (A.C.D.), Free University Medical Center, Amsterdam, The Netherlands
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Madách K, Molvarec A, Rigó J, Nagy B, Pénzes I, Karádi I, Prohászka Z. Elevated serum 70 kDa heat shock protein level reflects tissue damage and disease severity in the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Eur J Obstet Gynecol Reprod Biol 2008; 139:133-8. [PMID: 18249485 DOI: 10.1016/j.ejogrb.2007.12.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 11/08/2007] [Accepted: 12/23/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We have recently demonstrated that serum 70 kDa heat shock protein (Hsp70) levels are increased in the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome). The aim of the present study was to investigate in an independent, larger cohort of patients whether serum Hsp70 levels are related to laboratory markers of HELLP syndrome. STUDY DESIGN The study population included 14 patients with HELLP syndrome. Serum Hsp70 levels were measured by enzyme-linked immunosorbent assay. The relationship between serum Hsp70 levels and laboratory markers of hemolysis, hepatocellular damage, renal insufficiency, inflammation or disseminated intravascular coagulation (DIC), as well as platelet count was investigated by calculating correlation coefficients, standardized regression coefficients and by principal component analysis. RESULTS Serum Hsp70 levels showed a very strong correlation to the markers of hemolysis (plasma free hemoglobin level, serum lactate dehydrogenase activity, and total bilirubin level) and of hepatocellular injury (serum aminotransferase activities), supported also by principal component analysis. Furthermore, circulating Hsp70 concentration reflected the severity of HELLP syndrome as expressed by the significant inverse correlation to the lowest platelet count. By contrast, there was no relationship between serum Hsp70 levels and markers of inflammation, coagulation, fibrinolysis or renal insufficiency. CONCLUSION Elevated serum 70 kDa heat shock protein level seems to reflect tissue damage (hemolysis and hepatocellular injury) and disease severity in patients with HELLP syndrome. However, further investigations are needed to determine the clinical relevance of these findings.
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Affiliation(s)
- Krisztina Madách
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
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35
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George D, Vasanth L, Erkan D, Bass A, Salmon J, Lockshin MD. Primary antiphospholipid syndrome presenting as HELLP syndrome: a clinical pathology conference held by the Division of Rheumatology at Hospital for Special Surgery. HSS J 2007; 3:216-21. [PMID: 18751798 PMCID: PMC2504265 DOI: 10.1007/s11420-007-9043-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Accepted: 03/21/2007] [Indexed: 02/07/2023]
Affiliation(s)
- Diane George
- Department of Internal Medicine, St Lukes-Roosevelt Hospital Center, 1000 10th Avenue, New York, NY 10019, USA.
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Chhabra S, Qureshi A, Datta N. Perinatal outcome with HELLP/partial HELLP complicating hypertensive disorders of pregnancy. An Indian rural experience. J OBSTET GYNAECOL 2007; 26:531-3. [PMID: 17000499 DOI: 10.1080/01443610600810989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A total of 615 women with hypertensive disorders during pregnancy were the study subjects. Of these, 145 (23.58%) women had HELLP or partial HELLP (only one or two of the three components H,EL, LP). Overall, eight (1.3%), i.e. five out of 399 primigravida (1.2%) and three of the 216 multigravida (1.3%), had complete HELLP and the remaining 137 (22.2%) had partial HELLP. Of the 399 primigravida with hypertensive disorders, 107 (26.5%) had partial HELLP, statistically significantly more (p<0.002) than the 30 out of the 216 (13.8%) multigravida. In 210 (44.6%) out of 470 women with hypertension without HELLP/partial HELLP, labour was induced and the perinatal mortality rate (PMR) was 138.9 (58.06 in term and 363.63 in pre-term cases), and in the other 260 women in whom labour was not induced, PMR was 96.15 (in term cases 74.07 and in pre-term 120). Among the women with HELLP/partial HELLP (145), out of the 64 women in whom labour was induced, the PMR was 359.37 (235.29 in term and 500 in pre-term) and of those in whom labour was not induced (81), PMR was 209.87 (106 in term cases and 352.94 in pre-term). All the eight women with the full HELLP syndrome had labour induced, the PMR in these cases was 500. Overall, in women with HELLP/partial HELLP, the PMR was 275.8 and in the remainder with hypertensive disorders without HELLP/partial HELLP, it was 114.89.
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Affiliation(s)
- S Chhabra
- Department of Obstetrics and Gynaecology, Mahatma Gandhi Institute of Medical Sciences, Maharashtra, India.
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37
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Ellidokuz E, Uslan I, Demir S, Cevrioglu S, Tufan G. Transient postpartum diabetes insipidus associated with HELLP syndrome. J Obstet Gynaecol Res 2006; 32:602-4. [PMID: 17100823 DOI: 10.1111/j.1447-0756.2006.00464.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diabetes insipidus in pregnancy has different causes. The association of diabetes insipidus with disturbances of liver function has been reported, however, diabetes insipidus has rarely been reported in HELLP syndrome. We present a 23-year-old primigravida with a singleton gestation complicated by HELLP syndrome who developed postpartum diabetes insipidus. Labor was induced promptly to terminate pregnancy because of intrauterine fetal death and liver dysfunction. 1-deamino-8-D-arginine-vasopressin was administered. Diabetes insipidus and liver dysfunction resolved within 2 weeks. Development of diabetes insipidus may result from increased vasopressinase activity mainly caused by deterioration of liver functions caused by HELLP syndrome. In pregnant women with liver disease as a result of any cause, the development of diabetes insipidus should be assessed with particular attention.
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Affiliation(s)
- Ender Ellidokuz
- Department of Internal Medicine, Celal Bayar University, Turkey.
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39
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Molvarec A, Prohászka Z, Nagy B, Kalabay L, Szalay J, Füst G, Karádi I, Rigó J. Association of increased serum heat shock protein 70 and C-reactive protein concentrations and decreased serum alpha(2)-HS glycoprotein concentration with the syndrome of hemolysis, elevated liver enzymes, and low platelet count. J Reprod Immunol 2006; 73:172-179. [PMID: 17023052 DOI: 10.1016/j.jri.2006.07.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Revised: 07/19/2006] [Accepted: 07/24/2006] [Indexed: 11/23/2022]
Abstract
The primary aim of this study was to determine serum Hsp70 concentrations in HELLP syndrome. We measured also the serum concentrations of three acute phase proteins: C-reactive protein (CRP), alpha(2)-macroglobulin (AMG) and alpha(2)-HS glycoprotein (AHSG). Ten severe preeclamptic patients with HELLP syndrome, 20 severe preeclamptic patients without HELLP syndrome and 20 normotensive, healthy pregnant women were included in this case-control study. Serum concentrations of Hsp70, CRP, AMG and AHSG were measured using an enzyme-linked immunosorbent assay (Hsp70), particle-enhanced immunoturbidimetric assay (CRP) and radial immunodiffusion (AMG, AHSG). The serum Hsp70 and CRP concentrations were significantly higher, whereas the serum AHSG concentration was significantly lower in the HELLP group (H) than the severe preeclamptic (P) and control (C) groups (median (25-75 percentile); Hsp70: 2.02 ng/ml (0.76-2.23) (H) versus 0.54 ng/ml (0.47-0.79) (P), p<0.01, and 0.30 ng/ml (0.27-0.33) (C), p<0.001; CRP: 43.9 mg/l (27.1-84.5) (H) versus 6.5 mg/l (2.7-10.7) (P), p<0.001, and 2.5 mg/l (1.1-6.7) (C), p<0.001; AHSG: 588 microg/ml (492-660) (H) versus 654 microg/ml (576-768) (P), p<0.05, and 738 microg/ml (666-804) (C), p<0.01, respectively). The serum AMG concentration did not differ between the study groups. In the HELLP group, there was a statistically significant negative correlation between serum Hsp70 concentration and platelet count (Spearman R=-0.69, p=0.026). In conclusion, serum Hsp70 and CRP concentrations are increased, whereas serum AHSG concentration is decreased, in HELLP syndrome. The maternal systemic inflammation seems to be more pronounced in HELLP syndrome than preeclampsia without HELLP syndrome, as suggested by the alterations in serum CRP and AHSG levels. However, it requires further investigation to determine whether these changes are causes or consequences of the disease.
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Affiliation(s)
- Attila Molvarec
- Department of Obstetrics and Gynecology, Kútvölgyi Clinical Center, Semmelweis University, Budapest, Hungary.
| | - Zoltán Prohászka
- 3rd Department of Internal Medicine, Semmelweis University and Research Group on Metabolism and Atherosclerosis, Hungarian Academy of Sciences, Budapest, Hungary
| | - Bálint Nagy
- 1st Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - László Kalabay
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - János Szalay
- Department of Obstetrics and Gynecology, Kútvölgyi Clinical Center, Semmelweis University, Budapest, Hungary
| | - Georg Füst
- 3rd Department of Internal Medicine, Semmelweis University and Research Group on Metabolism and Atherosclerosis, Hungarian Academy of Sciences, Budapest, Hungary
| | - István Karádi
- 3rd Department of Internal Medicine, Semmelweis University and Research Group on Metabolism and Atherosclerosis, Hungarian Academy of Sciences, Budapest, Hungary
| | - János Rigó
- 1st Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
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Abstract
The present study compares neonatal outcome after preterm delivery of infants in pregnancies complicated by the HELLP syndrome or severe preeclampsia (PS). The maternal and neonatal charts of 71 out of a total of 409 pregnancies that were complicated by hypertensive disorders at Severance hospital between January 1995 and December 2004 were reviewed. Twenty-one pregnancies were complicated by HELLP syndrome and 50 pregnancies were complicated by PS. Fifty normotensive (NT) patients who delivered because of preterm labor comprised the control group. Results were analyzed by the chi-square test and ANOVA. Gestational age and maternal age at delivery were matched among the three groups. The neonatal outcomes of the HELLP syndrome group were compared with the PS and NT groups. There were significant differences between the HELLP syndrome group and the PS group in the incidence of intraventricular hemorrhage (IVH) (61.9% vs. 26%, p=0.006), sepsis (85.7% vs. 44%, p =0.003) and mechanical ventilation (MV) rate (81% vs. 54%, p=0.039). There were significant differences between the HELLP syndrome group and the NT group in the incidence of neonatal death (ND) (19.5% vs. 2.0%, p=0.034), respiratory distress syndrome (RDS) (38.1% vs. 8%, p=0.0045), IVH (61.9% vs. 4%, p < 0.0001), sepsis (85.7% vs. 14%, p < 0.0001), intensive care (IC) (85.7% vs. 24%, p < 0.0001) and MV rate (80.1% vs. 14%, p < 0.0001). There were also significant differences between the PS and NT groups in the incidence of ND (20% vs. 2%, p=0.0192), RDS (30% vs. 8%, p=0.0085), IVH (26% vs. 4%, p=0.0070), sepsis (44% vs. 14%, p=0.0015), IC (78% vs. 24%, p < 0.0001), MV rate (54% vs. 14%, p < 0.0001) and low 5-min APGAR score (50% vs. 16%, p=0.0005). This study shows increased morbidity in newborns of mothers complicated with HELLP syndrome and indicates that early, regular and high quality management of these patients is essential to improve both maternal and neonatal outcome.
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Affiliation(s)
- Hye Yeon Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Seok Sohn
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hak Lim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Euy Hyuk Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Ja Young Kwon
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Won Park
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Women's Life Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Han Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Women's Life Science Institute, Yonsei University College of Medicine, Seoul, Korea
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41
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Okafor UV, Efetie RE. Acute renal failure due to HELLP syndrome and acute renal failure in mid gestation. Int J Obstet Anesth 2005; 14:265-8. [PMID: 15935639 DOI: 10.1016/j.ijoa.2004.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2004] [Revised: 11/01/2004] [Accepted: 11/01/2004] [Indexed: 11/29/2022]
Abstract
A 34-year-old grand multipara (para 7, 4 alive) was managed at the National Hospital, Abuja, Nigeria for acute renal failure due to HELLP syndrome following referral from a peripheral hospital. She presented with a history of vomiting, headache, epigastric pain, loss of consciousness and tonic/clonic seizures. Though she was unsure of her exact dates, clinically the gestational age was estimated at 22 weeks. She was managed in the intensive care unit, following delivery of a macerated fetus within 15 h of hospital admission. The patient received mechanical ventilation and three sessions of haemodialysis as part of her successful management while in the intensive care unit. The uncommon presentation of eclampsia and HELLP syndrome before obvious preeclampsia is discussed, as well as the other signs and symptoms and patient management. The case also highlights the resource-poor environment of peripheral and tertiary hospitals in Nigeria.
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Affiliation(s)
- U V Okafor
- Department of Anaesthesia, National Hospital, Abuja, Nigeria.
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42
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Dawes SD. Can SSRIs reduce the risk of preeclampsia in pregnant, depressed patients? Med Hypotheses 2005; 64:33-6. [PMID: 15533606 DOI: 10.1016/j.mehy.2003.10.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2003] [Accepted: 10/17/2003] [Indexed: 11/29/2022]
Abstract
Preeclampsia causes substantial morbidity and mortality. A significant part of the etiology of preeclampsia involves endothelial damage and platelet activation and in this way can be conceived as an illness with a pathophysiology similar to coronary artery disease. Depression is an independent risk factor for the progression of cardiovascular disease [Am Heart J 140 (2000) S57] and there is evidence to suggest that it may be a risk factor for preeclampsia as well. SSRIs have been shown to reduce the progression of coronary artery disease, independent of improvement in mood. SSRIs may also reduce risk factors for preeclampsia in addition to treating depression in pregnancy. This is an important area for further research.
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Affiliation(s)
- Shandara Durkee Dawes
- Department of Psychiatry, Los Angeles Neuropsychiatric Institute, University of California, 760 Westwood Plaza, Room C8-846, Los Angeles, CA 90024, USA.
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Raijmakers MTM, Dechend R, Poston L. Oxidative stress and preeclampsia: rationale for antioxidant clinical trials. Hypertension 2004; 44:374-80. [PMID: 15326082 DOI: 10.1161/01.hyp.0000141085.98320.01] [Citation(s) in RCA: 214] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preeclampsia remains a frequent and potentially dangerous complication of pregnancy. The cause remains largely unknown, but oxidative stress and a generalized inflammatory state are features of the maternal syndrome. The placenta appears to be the principal source of free radical synthesis but maternal leukocytes and the maternal endothelium are also likely contributors. Recent reports have suggested an important role for placental trophoblast NAD(P)H oxidase in free radical generation in preeclampsia. The antioxidant vitamin E is now known to have multiple actions in addition to prevention of lipid peroxidation (ie, inhibition of NAD(P)H oxidase activation and the inflammatory response). In view of the abnormally low plasma vitamin C concentrations in preeclampsia, a combination of vitamins C and E is a promising prophylactic strategy for prevention of preeclampsia. Several multicenter randomized clinical trials are now underway. The potential use of antioxidants and the recognized, albeit modest, benefit of low-dose aspirin prophylaxis have heightened the need for a reliable predictive test for preeclampsia. A combination test involving several relevant biomarkers is likely to provide the best predictive potential.
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Affiliation(s)
- Maarten T M Raijmakers
- Maternal and Fetal Research Unit, Division of Reproductive Health, Endocrinology, and Development, King's College Hospital, St. Thomas' Hospital, London, UK
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Brandenburg VM, Frank RD, Heintz B, Rath W, Bartz C. HELLP syndrome, multifactorial thrombophilia and postpartum myocardial infarction. J Perinat Med 2004; 32:181-3. [PMID: 15085897 DOI: 10.1515/jpm.2004.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A case of postpartum acute myocardial infarction with intraventricular thrombus occurred in a woman with HELLP syndrome. Since coronary artery disease was ruled out angiographically, the assumed pathophysiological mechanism for myocardial malperfusion was intermittend coronary vasospasm and thrombosis. There were several thrombophilic risk factors detectable (heterozygous factor V Leiden, low levels of antithrombin III, protein S deficiency), whose possible impact in this rare but severe clinical condition is discussed.
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Affiliation(s)
- Vincent M Brandenburg
- Department of Nephrology and Clinical Immunology, University Hospital, RWTH Aachen, Aachen, Germany.
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Strand S, Strand D, Seufert R, Mann A, Lotz J, Blessing M, Lahn M, Wunsch A, Broering DC, Hahn U, Grischke EM, Rogiers X, Otto G, Gores GJ, Galle PR. Placenta-derived CD95 ligand causes liver damage in hemolysis, elevated liver enzymes, and low platelet count syndrome. Gastroenterology 2004; 126:849-58. [PMID: 14988839 DOI: 10.1053/j.gastro.2003.11.054] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS The HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome is a life-threatening complication during pregnancy. The associated liver disease may be severe, and maternal hepatic complications may progress to the point that transplantation becomes necessary. CD95 (APO-1, Fas)-mediated apoptosis of liver cells is one of the major pathogenic mechanisms during liver disease. The interaction of CD95 with its ligand, CD95L(FasL), induces apoptosis and thus the source of the death-inducing ligand is critical for understanding the pathomechanism of liver damage involving the CD95-system. METHODS Sera from HELLP patients were analyzed and used in cell culture experiments to study CD95-mediated apoptosis. We established a mouse model for placenta-induced liver damage and used a new therapeutical agent, LY498919, to block CD95 apoptosis. RESULTS We describe apoptosis in the liver of HELLP patients and cytotoxic activity for primary human hepatocytes in HELLP serum. Blocking of CD95 signaling reduced the cytotoxic activity of HELLP serum. In addition, cytotoxic activity increased as HELLP syndrome developed. Furthermore, CD95L was found to be produced in the placenta and extracts of placenta were cytotoxic for human hepatocytes. Injection of mouse placenta extract in mice induces liver damage that could be prevented by blocking CD95L. CONCLUSIONS Taken together, these data suggest that CD95L derived from the placenta acts systemically and is a primary cause of liver damage in HELLP syndrome. Our results also show that blocking of CD95L can reduce liver cell apoptosis, indicating that such a strategy may have therapeutic advantages.
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Affiliation(s)
- Susanne Strand
- Department of Internal Medicine I, Johannes Gutenberg University, Mainz, Germany.
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Carrascal E, González M, Miguel JD, Ortiz C. Preeclampsia grave síndrome HELLP posparto. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2004. [DOI: 10.1016/s0210-573x(04)77361-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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47
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Kidner MC, Flanders-Stepans MB. A Model for the HELLP Syndrome: The Maternal Experience. J Obstet Gynecol Neonatal Nurs 2004; 33:44-53. [PMID: 14971552 DOI: 10.1177/0884217503261131] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the experience of mothers whose pregnancies were complicated with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) and to determine if such experiences could be clustered by common themes from which a model could emerge. DESIGN Retrospective, descriptive, qualitative study utilizing grounded theory analysis. SETTING Participants were interviewed in their homes via telephone. Participants were from Kansas, Maine, Maryland, Michigan, Minnesota, Mississippi, South Carolina, Utah, and Wyoming, representing both urban and rural settings. PARTICIPANTS Nine self-selected survivors of HELLP syndrome. RESULTS The essential structure of the experience of HELLP syndrome can be expressed as a circle of no control and not knowing, which included the five themes of premonition, symptoms, betrayal, whirlwind, and loss. The pervading emotions expressed were fear (of death), frustration, anger, and guilt. HELLP syndrome represents a unique maternal experience that can be expressed in a model.
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Affiliation(s)
- Maria C Kidner
- South Big Horn County Critical Care Access, Basin, WY 82410, USA.
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Wicke C, Pereira PL, Neeser E, Flesch I, Rodegerdts EA, Becker HD. Subcapsular liver hematoma in HELLP syndrome: Evaluation of diagnostic and therapeutic options--a unicenter study. Am J Obstet Gynecol 2004; 190:106-12. [PMID: 14749644 DOI: 10.1016/j.ajog.2003.08.029] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Subcapsular liver hematoma formation has been reported in less than 2% of pregnancies complicated by HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. The purpose of this study was to identify the main diagnostic and therapeutic options for management of these patients. STUDY DESIGN In this 10-year retrospective review, we performed a computer-directed search of all cases of confirmed HELLP syndrome with hepatic hematoma treated in the surgical department of our tertiary care referral medical center. RESULTS Five patients with subcapsular liver hematoma in HELLP syndrome could be identified. All patients received transabdominal ultrasound, computed tomography, or magnetic resonance imaging. Conservative treatment was successful in three patients. Emergency surgical intervention was necessary in two patients, including one liver transplantation. CONCLUSION The case series shows the full diagnostic spectrum with transabdominal ultrasound, computed tomography, and magnetic resonance imaging, as well as the different therapeutic options varying from conservative therapy to operative management, including liver transplantation.
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Affiliation(s)
- Corinna Wicke
- Department of General Surgery, University Hospital Tuebingen, Tuebingen, Germany.
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Bridges EJ, Womble S, Wallace M, McCartney J. Hemodynamic Monitoring in High-Risk Obstetrics Patients, II. Crit Care Nurse 2003. [DOI: 10.4037/ccn2003.23.5.52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Elizabeth J. Bridges
- Elizabeth J. Bridges is Deputy Commander of the 59th Clinical Research Squadron and senior nurse researcher at the 59th Medical Wing, Lackland AFB, San Antonio, Tex
| | - Shannon Womble
- Shannon Womble, Marlene Wallace, and Jerry McCartney are staff nurses in the surgical intensive care unit of the 59th Medical Wing at Lackland AFB
| | - Marlene Wallace
- Shannon Womble, Marlene Wallace, and Jerry McCartney are staff nurses in the surgical intensive care unit of the 59th Medical Wing at Lackland AFB
| | - Jerry McCartney
- Shannon Womble, Marlene Wallace, and Jerry McCartney are staff nurses in the surgical intensive care unit of the 59th Medical Wing at Lackland AFB
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50
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Medical Misspellings. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200305000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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