Hypertension—Management of Hypertensive Disorders of Pregnancy According to International Guidelines: A Panel Discussion (Case 4: HELLP Syndrome)

Abstract Background Hypertensive disorders of pregnancy complicate around 6% of pregnancies and accounts for 19% of maternal death in Ethiopia. The current review aimed to assess maternal and perinatal outcomes of pregnancies complicated by hypertension in Ethiopia. Methods A systematic review and meta-analysis was done on the outcome of hypertensive disorder among pregnant women in Ethiopia. Literature search was made in five databases and Statistical analyses were carried out by using Stata 14 software. The pooled prevalence of maternal death, HELLP syndrome, perinatal death, and low birth weight was calculated using a random-effects model. Egger’s test and funnel plot were used to evaluate publication bias. The Cochran Q test and I2 test statistics were used to test the heterogeneity of studies. Result Thirteen studies included in the review, with an overall sample size of 5894 women diagnosed to have hypertensive disorder of pregnancy. The pooled prevalence of maternal death was estimated to be 4% (95% CI: 2, 6%). The pooled prevalence of HELLP syndrome was 13% (95% CI: 10, 16%). Other complications such as pulmonary edema, kidney injury, hepatic injury, placental abruption, and aspiration pneumonia were also reported. Perinatal death was observed in one-fourth of women with HDP 25% (95% CI: 18, 32%). The pooled prevalence of low birth weight neonate in a woman with HDP is 37% (95% CI, 27, 48%). Conclusions In Ethiopia, the prevalence of perinatal and maternal mortality among pregnant women with one of the hypertensive disorders were found to be higher than rates reported from high income as well as most of the low and middle income countries. For instance, one in four of pregnancies complicated by hypertensive disorder end up in perinatal death in Ethiopia. HELLP syndrome, placental abruption, pulmonary edema, renal damage, prematurity, perinatal asphyxia, and low birth weight were also commonly reported. To improve the health outcomes of hypertensive disorders of pregnancy, it is recommended to improve utilization of maternal health service; early detection and early referral of pregnant women with hypertensive disorder; advocating policies and strategies that improves the quality of health care that a pregnant woman and her newborn receive.

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Thrombocytopenia in hypertensive disorders of pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180409 ◽

2018 ◽

Vol 7 (3) ◽

pp. 848

Author(s):

Rupakala B. M. ◽

Ritika Gupta ◽

Vishma H. Shetty ◽

Sailakshmi M. P. A.

Keyword(s):

Hellp Syndrome ◽

Gestational Hypertension ◽

Severe Thrombocytopenia ◽

Hypertensive Disorders Of Pregnancy ◽

Medical College ◽

Normal Platelet ◽

Hypertensive Disorders ◽

Gestational Thrombocytopenia ◽

Mild Preeclampsia ◽

Foetal Outcome

Background: Thrombocytopenia is defined as a platelet count of less than 150×103 μl. It is commonly diagnosed and has attracted more interest from researchers during recent years, especially in Hypertensive disorders of pregnancy. This study was done to estimate the incidence of thrombocytopenia in pregnant women diagnosed with hypertensive disorders of pregnancy and to correlate its severity with the degree of thrombocytopenia.Methods: In the study 150 women admitted in the OBG Department at Rajarajeswari Medical College and Hospital, Bengaluru during August 2015-August 2016 were included. Hypertensive disorders of pregnancy cases were classified into: Gestational hypertension, mild preeclampsia, severe preeclampsia, haemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome and eclampsia. The incidence and severity of thrombocytopenia along with maternal and foetal complications encountered in the five groups were analysed. Data were arranged in Microsoft Excel version 2010, and statistically analysed by SPSS version 23.Results: Preeclampsia- mild (29.25%) and severe (22.5%), accounted for most of the cases followed by eclampsia (3%) and gestational HTN (1.5%). Among these hypertensive patients, mild thrombocytopenia was noted in 60 cases (40%), moderate thrombocytopenia 48 (32%), severe thrombocytopenia 12 (8%), and normal platelet counts 30 (20%) were noted. Poor maternal outcome was seen 10.67% cases due to HELLP syndrome and postpartum haemorrhage. Poor foetal outcome was seen in 16% cases due to intrauterine growth restriction and perinatal mortality.Conclusions: Hypertensive disorders of pregnancy is recognized as a major cause of gestational thrombocytopenia. Careful follow up during and after pregnancy is recommended.

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Assessment of the quality and content of national and international guidelines on hypertensive disorders of pregnancy using the AGREE II instrument

BMJ Open ◽

10.1136/bmjopen-2015-009189 ◽

2016 ◽

Vol 6 (1) ◽

pp. e009189 ◽

Cited By ~ 12

Author(s):

Alessandra N Bazzano ◽

Erik Green ◽

Anita Madison ◽

Andrew Barton ◽

Veronica Gillispie ◽

...

Keyword(s):

Hypertensive Disorders Of Pregnancy ◽

Agree Ii ◽

International Guidelines ◽

Hypertensive Disorders ◽

Agree Ii Instrument

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Correlation Between Maternal Plasma Thrombomodulin and Infant Birth Weight in Hypertensive Disorders of Pregnancy

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029608325543 ◽

2008 ◽

Vol 15 (2) ◽

pp. 166-170 ◽

Cited By ~ 1

Author(s):

Füsun G. Varol ◽

Levent Ozgen ◽

N. Cenk Sayin ◽

Muzaffer Demir

Keyword(s):

Birth Weight ◽

Pregnant Women ◽

Hellp Syndrome ◽

Maternal Plasma ◽

Severe Preeclampsia ◽

Assay Method ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Infant Birth ◽

In Pregnancy

Objective: To evaluate the association between maternal plasma thrombomodulin levels and infant birth weights in pregnancy-induced hypertension. Study design: Plasma thrombomodulin levels were measured in 80 pregnant women living in the Trakya region of Turkey. Of these patients, 30 were with severe preeclampsia, 10 with HELLP syndrome, 10 with eclampsia, and 30 were normotensive healthy pregnant women. Plasma thrombomodulin levels were determined by the enzyme-linked immunosorbent assay method. The correlation analysis between thrombomodulin and birth weight and placental weights was done using analysis of variance and Bonferroni test (significance at P < .05). Kruskal-Wallis statistical analysis was performed in comparison of the descriptive and laboratory data (significance at P < .05). Results: The plasma thrombomodulin values in hypertensive disorders in pregnancy were found to be highly correlated with the infant birth weights (P < .001). In HELLP syndrome, the highest thrombomodulin levels (94.69 + 10.41 ng/mL) were associated with the lowest infant birth weight (1509.70 + 187.55 g) in the study population. Thrombomodulin in eclampsia (81.37 + 3.59 ng/mL) showed an association with infant birth weight (2078 + 132.65 g). Although thrombomodulin levels in severe preeclampsia (67.15 + 3.72 ng/mL) were associated with the values (1748.20 + 132.62 g) in infant birth weight, thrombomodulin levels of the control group demonstrated the mean (48.06 + 2.45) with the highest infant birth weight (3228.85 + 84.83) in the total group. Conclusion: Elevated plasma thrombomodulin levels in hypertensive disorders of pregnancy were well correlated with related infant birth weights of these pathologies. Plasma thrombomodulin levels might point out placental vascular endothelial damage reflecting on infant birth weights.

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