Maternal Bradycardia Heralding Deteriorating HELLP Syndrome (Pregnancy Hypertension)

Preeclampsia, eclampsia, and HELLP syndrome, are a continuum of a dangerous disease process that can occur in pregnancy. Preeclampsia is defined by new onset hypertension and proteinuria. In more severe cases, preeclampsia can be associated with pulmonary edema, oliguria, persistent headaches, and impaired liver function. These symptoms reveal maternal end organ damage which may result in danger to the fetus such as oligohydramnios, decreased fetal growth, and placental abruption. The defining difference between preeclampsia and eclampsia is the presence of new onset seizure activity. HELLP syndrome occurs when the mother experiences hemolysis, elevated liver enzymes, and low platelets. This syndrome is seen in about 0.6% of pregnancies. Each of these conditions (preeclampsia, eclampsia, and HELLP) increase both the fetal and maternal morbidity and mortality rates with the most definitive cure being delivery of child and placenta.A 28 year-old Caucasian, G1P0 female at 26w4d presented to OB triage on the recommendation of her physician due to elevated uric acid levels and a recorded blood pressure of 180/110. The patient reported rapid onset of weight gain, facial edema, diminished fetal movements, and frequent headaches. Although the patient denied labor symptoms, she complained of back pain and was admitted to the hospital at 26w4d for observation due to elevated blood pressures. The patient was diagnosed with preeclampsia with severe features. As her presentation progressed, the patient developed massive ascites and pulmonary edema along with decreasing platelet counts and increasing liver enzyme values. Due to decreasing biophysical profile (BPP) scores of the fetus and decompensating lab values of the mother, an emergency cesarean was performed for the safety of mother and baby.This case presentation demonstrates the progression of hypertensive disorders of pregnancy with a rare and severe presentation of early-onset preeclampsia with severe features, pulmonary edema, and massive ascites that ultimately led to class III HELLP syndrome and extreme prematurity of the infant.

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Human Epididymis Protein 4 in Women With Severe Preeclampsia / HELLP Syndrome

Case Medical Research ◽

10.31525/ct1-nct03891394 ◽

2019 ◽

Author(s):

Keyword(s):

Hellp Syndrome ◽

Severe Preeclampsia ◽

Human Epididymis Protein 4 ◽

Human Epididymis

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A Rare Case of Expanded Dengue, Evans Syndrome, Hellp Syndrome & Multiorgan Dysfunction

Indian Journal of Public Health Research & Development ◽

10.37506/v10/i12/2019/ijphrd/191932 ◽

2019 ◽

Vol 10 (12) ◽

pp. 171

Author(s):

N. K. Sundaray ◽

Srikant Kumar Dhar ◽

Chandan Das ◽

P. K. Tudu ◽

S. C. Das ◽

...

Keyword(s):

Hellp Syndrome ◽

Rare Case ◽

Evans Syndrome ◽

Multiorgan Dysfunction

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FP739PREECLAMPSIA, HELLP-SYNDROME AND THROMBOTIC MICROANGIOPATHY(TMA)-SIGNS DURING PREGNANCY AFTER KIDNEY TRANSPLANTATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy104.fp739 ◽

2018 ◽

Vol 33 (suppl_1) ◽

pp. i295-i295

Author(s):

Tatyana Kirsanova ◽

Maria Vinogradova ◽

Alina Kolyvanova ◽

Natalia Kravchenko ◽

Tatyana Fedorova

Keyword(s):

Kidney Transplantation ◽

Thrombotic Microangiopathy ◽

Hellp Syndrome

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Hydroxychloroquine prophylaxis for preeclampsia, hypertension and prematurity in pregnant patients with systemic lupus erythematosus: A meta-analysis

Lupus ◽

10.1177/09612033211007199 ◽

2021 ◽

pp. 096120332110071

Author(s):

Jiaoniu Duan ◽

Dan Ma ◽

Xiaoting Wen ◽

Qianyu Guo ◽

Jinfang Gao ◽

...

Keyword(s):

Lupus Erythematosus ◽

English Language ◽

Gestational Hypertension ◽

Meta Analysis ◽

Fetal Outcomes ◽

Pregnancy Hypertension ◽

Cochrane Database ◽

Newcastle Ottawa Scale ◽

Prospective Cohorts ◽

Ottawa Scale

Objectives This meta-analysis aimed to evaluate the effectiveness of HCQ in improving the maternal and fetal outcomes in pregnancies with SLE. Methods A literature search was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane database for relevant English language articles, and Wanfang, CNKI and VIP for Chinese articles, from the databases’ inception to April 30, 2020. These studies compared the maternal and/or fetal outcomes between pregnant patients with SLE who were administered HCQ during pregnancy (HCQ+ group) and those who were not administered HCQ (HCQ− group). Two investigators extracted the data and assessed the quality using the Newcastle-Ottawa Scale (NOS) and GRADE criteria independently. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated. All statistical analyses were conducted using the Stata 12.0 software. Results Nine studies involving 1132 pregnancies were included in the study (3 case controls, 2 prospective cohorts, 4 retrospective cohorts). Preeclampsia, gestational hypertension, and prematurity were significantly lower in the HCQ+ group than in the HCQ− group (OR 0.35, 95% CI 0.21–0.59), (OR 0.41, 95% CI 0.19–0.89) and (OR 0.55, 95% CI 0.36–0.86), respectively. There were no significant differences in the rates of HELLP Syndrome (OR 0.88, 95% CI 0.19–3.96), gestational diabetes (OR 2.3, 95% CI 0.44–12.12), thrombotic events (OR 0.26, 95% CI 0.05–1.51), spontaneous abortion (OR 1.77, 95% CI 0.96–3.26), premature rupture of membranes (OR 0.58, 95% CI 0.24–1.39), oligohydramnios (OR 0.90, 95% CI 0.38–2.14), live birth (OR 1.22, 95% CI 0.60–2.47), stillbirth (OR 1.00, 95% CI 0.50–2.00), congenital malformation (OR 0.53, 95% CI 0.14–2.04), low birth weight (OR 0.77, 95% CI 0.43–1.39), intrauterine distress (OR 1.07, 95% CI 0.41–2.76,), intrauterine growth restriction (OR 0.57, 95% CI 0.06–5.43), or five-minute APGAR score <7 (OR 0.72, 95% CI 0.20–2.58) between the two groups. Conclusions HCQ treatment during pregnancy could reduce the risk of preeclampsia, pregnancy hypertension and prematurity in SLE patients. The certainty of evidence is high but majority of the studies included are retrospective studies and not randomized controlled trials. Therefore, the multidisciplinary management of pregnant patients with SLE should promote HCQ use, irrespective of disease activity or severity.

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Haemolysis, elevated liver enzymes and low platelets: Diagnosis and management in critical care

Journal of the Intensive Care Society ◽

10.1177/17511437211025410 ◽

2021 ◽

pp. 175114372110254

Author(s):

Evangelia Poimenidi ◽

Yavor Metodiev ◽

Natasha Nicole Archer ◽

Richard Jackson ◽

Mansoor Nawaz Bangash ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critical Care ◽

Liver Failure ◽

Hellp Syndrome ◽

Seizure Control ◽

Liver Enzymes ◽

Kidney Injury ◽

Definitive Treatment ◽

Multisystem Disease ◽

Elevated Liver Enzymes

A thirty-year-old pregnant woman was admitted to hospital with headache and gastrointestinal discomfort. She developed peripheral oedema and had an emergency caesarean section following an episode of tonic-clonic seizures. Her delivery was further complicated by postpartum haemorrhage and she was admitted to the Intensive Care Unit (ICU) for further resuscitation and seizure control which required infusions of magnesium and multiple anticonvulsants. Despite haemodynamic optimisation she developed an acute kidney injury with evidence of liver damage, thrombocytopenia and haemolysis. Haemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome, a multisystem disease of advanced pregnancy which overlaps with pre-eclampsia, was diagnosed. HELLP syndrome is associated with a range of complications which may require critical care support, including placental abruption and foetal loss, acute kidney injury, microangiopathic haemolytic anaemia, acute liver failure and liver capsule rupture. Definitive treatment of HELLP is delivery of the fetus and in its most severe forms requires admission to the ICU for multiorgan support. Therapeutic strategies in ICU are mainly supportive and include blood pressure control, meticulous fluid balance and possibly escalation to renal replacement therapy, mechanical ventilation, neuroprotection, seizure control, and management of liver failure-related complications. Multidisciplinary input is essential for optimal treatment.

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