Pre-eclampsia and related disorders

2018 ◽  
Author(s):  
Kate Wiles ◽  
Catherine Nelson-Piercy
Keyword(s):  
Liver Enzymes ◽  
Post Partum ◽  
Kidney Injury ◽  
Disease Course ◽  
Common Complication ◽  
Thrombotic Microangiopathies ◽  
Elevated Liver Enzymes ◽  
Acute Fatty Liver ◽  
Supportive Management ◽  
New Onset

Pre-eclampsia is a pregnancy-specific condition diagnosed by new-onset hypertension and proteinuria after 20 weeks’ gestation. The incidence of pre-eclampsia means that it is both the most prevalent cause of acute kidney injury (AKI) in pregnancy and the commonest glomerular disease in the world. This chapter outlines the diagnosis and management of pre-eclampsia. Particular emphasis is given to the post-partum disease course as this is when a specialist nephrology opinion may be sought. HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome is a variant of severe pre-eclampsia. The most important differential diagnoses of HELLP syndrome are the thrombotic microangiopathies. Pregnancy can act as a trigger for both for new disease and flare of thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome. AKI is a common complication of acute fatty liver of pregnancy. The diagnosis and supportive management of this condition are considered.

Successful treatment with eculizumab in a patient with pregnancy-associated atypical hemolytic uremic syndrome

2021 ◽  
pp. 1753495X2110199
Author(s):  
Mehmet Nuri Duran ◽  
Fatma Beyazit ◽  
Mesut Erbaş ◽  
Onur Özkavak ◽  
Celal Acar ◽  
...  
Keyword(s):  
Haemolytic Uraemic Syndrome ◽  
Gestational Hypertension ◽  
Severe Renal Impairment ◽  
Post Partum ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Kidney Injury ◽  
Rapid Improvement ◽  
Plasma Therapy ◽  
Elevated Liver Enzymes ◽  
Atypical Haemolytic Uraemic Syndrome

Pregnancy‐associated atypical haemolytic uraemic syndrome is a rare and potentially lethal complement-mediated disorder. It can mimic preeclampsia, gestational hypertension, thrombotic thrombocytopenic purpura and hemolysis, elevated liver enzymes and low platelets syndrome. Thus, it can be hard to distinguish pregnancy‐associated atypical haemolytic uraemic syndrome from other causes in peri/post-partum women presenting with features of microangiopathic haemolytic anemia, thrombocytopenia and acute kidney injury. We present a case of a 35-year-old woman in her third pregnancy at 32 weeks’ gestation who underwent caesarean section due to fetal distress. She developed severe renal impairment, thrombocytopenia and neurologic symptoms within 24 hours after delivery. A diagnosis of pregnancy‐associated atypical haemolytic uraemic syndrome was provided, and treatment with plasma therapy followed by eculizumab was initiated. A rapid improvement of both clinical and laboratory parameters was observed. This case demonstrates the significance of early initiation of anti-complement therapy to prevent irreversible renal damage and possible death in women with pregnancy‐associated atypical haemolytic uraemic syndrome.

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

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.

scholarly journals Comparison of Maternal and Neonatal Outcomes between Acute Fatty Liver of Pregnancy and Hemolysis, Elevated Liver Enzymes and Low Platelets Syndrome: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Sau Xiong Ang ◽  
Chie-Pein Chen ◽  
Fang-Ju Sun ◽  
Chen-Yu Chen
Keyword(s):  
Cohort Study ◽  
Fatty Liver ◽  
Retrospective Cohort Study ◽  
Hellp Syndrome ◽  
Retrospective Cohort ◽  
Liver Enzymes ◽  
Neonatal Outcomes ◽  
Elevated Liver Enzymes ◽  
Acute Fatty Liver ◽  
Maternal And Neonatal Outcomes

Abstract Background: Acute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome are two uncommon disorders that mimic each other clinically, but are distinct pathophysiologically. This study aimed to compare maternal and neonatal outcomes between AFLP and HELLP syndrome.Methods: This retrospective cohort study was performed at a tertiary referral center in Taiwan between June 2004 and April 2020. We used the Swansea Criteria to diagnose AFLP, and the Tennessee Classification System to diagnose HELLP syndrome. Maternal characteristics, laboratory data, complications, and neonatal outcomes were analyzed.Results: During the study period, 21 women had AFLP and 80 women had HELLP syndrome. There was a higher rate of preeclampsia (95.0% versus 23.8%) in the HELLP syndrome group compared to the AFLP group. However, the AFLP group had more other maternal complications including jaundice (85.7% versus 13.8%), acute kidney injury (61.9% versus 15.0%), disseminated intravascular coagulopathy (66.7% versus 8.8%), and sepsis (47.6% versus 10.0%) compared to the HELLP syndrome group. Nevertheless, higher rates of small for gestational age neonates (57.1% versus 33.3%), neonatal respiratory distress syndrome (39.2% versus 8.3%) and neonatal sepsis (34.2% versus 12.5%) were noted in the HELLP syndrome group.Conclusions: AFLP is associated with a higher rate of multiple organ dysfunction in mothers, whereas HELLP syndrome is associated with a higher rate of neonatal morbidity.

scholarly journals Hemolysis, Elevated Liver Enzymes, Low Platelets Syndrome Superimposed on Hemolytic Uremic Syndrome

2017 ◽  
Vol 39 (04) ◽  
pp. 195-198 ◽  
Author(s):  
Inês Martins ◽  
Madalena Conceição ◽  
Paulo Gomes ◽  
Nuno Clode
Keyword(s):  
Hemolytic Uremic Syndrome ◽  
Hellp Syndrome ◽  
Liver Enzymes ◽  
Future Research ◽  
Thrombotic Microangiopathies ◽  
Laboratory Findings ◽  
Reproductive Immunology ◽  
Elevated Liver Enzymes ◽  
Uremic Syndrome ◽  
Nephrotic Range Proteinuria

AbstractA pregnancy complicated by typical hemolytic uremic syndrome (HUS) and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome is reported. At 20 weeks of gestation, a case of HUS was diagnosed, with Shiga toxin-producing Escherichia coli identified. Plasmapheresis allowed continuation of the pregnancy for 5 weeks. Superimposed preeclampsia and HELLP syndrome were diagnosed after the establishment of nephrotic range proteinuria, hypertension and recurrence of hemolysis. This is a singular case, as it demonstrates that HELLP syndrome can superimpose upon HUS, a fact that can impact future research on reproductive immunology. It also reminds clinicians that the overlapping of clinical and laboratory findings in HELLP syndrome makes the diagnosis of other thrombotic microangiopathies during pregnancy a clinical challenge.

scholarly journals Differentiation of acute fatty liver of pregnancy from syndrome of hemolysis, elevated liver enzymes and low platelet counts

2014 ◽  
Vol 40 (3) ◽  
pp. 641-649 ◽  
Author(s):  
Hisanori Minakami ◽  
Mamoru Morikawa ◽  
Takahiro Yamada ◽  
Takashi Yamada ◽  
Rina Akaishi ◽  
...  
Keyword(s):  
Fatty Liver ◽  
Liver Enzymes ◽  
Platelet Counts ◽  
Elevated Liver Enzymes ◽  
Acute Fatty Liver

scholarly journals Liver Transplantation for Acute Liver Failure at 11-Week Gestation with Successful Maternal and Fetal Outcome

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Vinaya C. Maddukuri ◽  
Courtney D. Stephenson ◽  
Lon Eskind ◽  
William A. Ahrens ◽  
Preston Purdum ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Liver Enzymes ◽  
First Trimester ◽  
Fetal Outcome ◽  
Third Trimester ◽  
Elevated Liver Enzymes ◽  
Acute Fatty Liver ◽  
First Trimester Of Pregnancy

Acute liver failure (ALF) during pregnancy is very uncommon. Pregnancy-specific liver conditions like hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome and acute fatty liver of pregnancy can cause ALF at term or postpartum, but, typically occur during the third trimester. Most of these patients recover spontaneously after delivery, but, on occasion, they require liver transplantation in the postpartum period. However, ALF during the first and second trimester of pregnancy requiring antepartum liver transplantation is rare. Only fifteen cases of liver transplantation during pregnancy have been reported, and very few occurred during the first trimester. We report a Woman who developed acute liver failure during the first trimester of pregnancy and underwent successful liver transplantation at 11-week gestation, followed by successful delivery of the fetus at 30 weeks. To our knowledge, this is the earliest case of successful liver transplantation during pregnancy followed by successful fetal outcome. We discuss management of the patient and fetus before, during, and after liver transplantation and review the literature on antepartum liver transplant in pregnancy.

scholarly journals Comparison of maternal and neonatal outcomes between acute fatty liver of pregnancy and hemolysis, elevated liver enzymes and low platelets syndrome: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sau Xiong Ang ◽  
Chie-Pein Chen ◽  
Fang-Ju Sun ◽  
Chen-Yu Chen
Keyword(s):  
Cohort Study ◽  
Fatty Liver ◽  
Retrospective Cohort Study ◽  
Hellp Syndrome ◽  
Retrospective Cohort ◽  
Liver Enzymes ◽  
Neonatal Outcomes ◽  
Elevated Liver Enzymes ◽  
Acute Fatty Liver ◽  
Maternal And Neonatal Outcomes

Abstract Background Acute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome are two uncommon disorders that mimic each other clinically, but are distinct pathophysiologically. This study aimed to compare maternal and neonatal outcomes between AFLP and HELLP syndrome. Methods This retrospective cohort study was performed at a tertiary referral center in Taiwan between June 2004 and April 2020. We used the Swansea Criteria to diagnose AFLP, and the Tennessee Classification System to diagnose HELLP syndrome. Maternal characteristics, laboratory data, complications, and neonatal outcomes were compared. We analyzed the categorical variables with Chi-square test or Fisher’s exact test and continuous variables with Student’s t test or Mann-Whitney U test. Subsequent logistic regression analyses adjusting by potential confounding factors with significant difference were analyzed. Results During the study period, 21 women had AFLP and 80 women had HELLP syndrome. There was a higher rate of preeclampsia (95.0 % versus 23.8 %) in the HELLP syndrome group compared to the AFLP group. However, the AFLP group had more other maternal complications including jaundice (85.7 % versus 13.8 %), acute kidney injury (61.9 % versus 15.0 %), disseminated intravascular coagulopathy (66.7 % versus 8.8 %), and sepsis (47.6 % versus 10.0 %) compared to the HELLP syndrome group. Nevertheless, higher rates of small for gestational age neonates (57.1 % versus 33.3 %), neonatal respiratory distress syndrome (39.2 % versus 8.3 %) and neonatal sepsis (34.2 % versus 12.5 %) were noted in the HELLP syndrome group. Conclusions AFLP is associated with a higher rate of multiple organ dysfunction in mothers, whereas HELLP syndrome is associated with a higher rate of neonatal morbidity.

scholarly journals Subcapsular hepatic hematoma as a complication of severe preeclampsia: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Kiel Luhning ◽  
Hilary MacCormick ◽  
Bruce Macaulay ◽  
Marianna Saunders ◽  
Catherine Craig
Keyword(s):  
Hemolytic Anemia ◽  
Conservative Management ◽  
Liver Enzymes ◽  
Thoracoscopic Surgery ◽  
Severe Preeclampsia ◽  
Hepatic Hematoma ◽  
Video Assisted ◽  
Elevated Liver Enzymes ◽  
Video Assisted Thoracoscopic Surgery ◽  
New Onset

Abstract Background Subcapsular hepatic hematoma is a rare and life-threatening complication of pregnancy. It is most commonly associated with severe preeclampsia and hemolytic anemia, elevated liver enzymes, and low platelets syndrome. Patients with subcapsular hepatic hematoma typically present with epigastric, right upper quadrant or shoulder pain, nausea and vomiting, and/or shortness of breath. Here we describe a patient with a classic pain presentation, a large unruptured hematoma, and an unusual postpartum course. Case A 40-year-old gravida 1 para 0 Caucasian woman presented at 39 + 6 weeks gestational age with a 3-day history of new onset pain in an otherwise uncomplicated pregnancy. She described the pain along her right torso as severe, shooting, and sharp, but at times pleuritic in nature. She was found to have new onset preeclampsia and hemolytic anemia, elevated liver enzymes, and low platelets syndrome. Induction of labor was initiated and eventually she delivered by cesarean section. Her pain persisted in the postpartum period and abdominal computed tomography scan revealed a 16 cm subcapsular hepatic hematoma. Despite the hematoma being thin walled, conservative management was recommended by the general surgeon. She then re-presented on postpartum day 15 with tachypnea, dyspnea, and pleuritic chest pain. Secondary to the subcapsular hepatic hematoma, she then developed an infected and loculated, large pleural effusion. This required video-assisted thoracoscopic surgery before her eventual discharge home on postpartum day 21. Conclusions There should be high clinical suspicion of subcapsular hepatic hematoma in patients with persistent pain in the right upper quadrant of the abdomen. Urgent imaging to investigate for subcapsular hepatic hematoma is then indicated. Cesarean delivery without labor and treatment for severe preeclampsia should be undertaken if subcapsular hepatic hematoma is found. Conservative management and serial imaging are reasonable for the follow-up of a large, unruptured hematoma. Hepatic artery embolization should also be considered. Subcapsular hepatic hematoma may be complicated by infected pleural effusions and require video-assisted thoracoscopic surgery.

Acute kidney injury in pregnancy

2015 ◽  
Author(s):  
Kate Wiles ◽  
Catherine Nelson-Piercy
Keyword(s):  
Acute Kidney Injury ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Adverse Pregnancy Outcome ◽  
Post Partum ◽  
Kidney Injury ◽  
Obstructive Nephropathy ◽  
Elevated Liver Enzymes ◽  
In Pregnancy

The diagnosis of acute kidney injury in pregnancy is complicated by physiological changes to both kidney and circulation; although a serum creatinine of higher than 90 μ‎‎‎mol/L is considered diagnostic of kidney injury in pregnancy. The aetiology of acute kidney injury in pregnancy mirrors that of the non-pregnant patient with the addition of pregnancy-specific conditions such as pre-eclampsia, HELLP syndrome (haemolysis, elevated liver enzymes, low platelets), post-partum haemorrhage, and acute fatty liver of pregnancy. In early pregnancy, the major additional concerns are septic abortion and hyperemesis. Urinary tract infection is common in pregnancy. Surveillance and treatment thresholds reflect the recognized association between urinary tract infection and adverse pregnancy outcome. Obstructive nephropathy is difficult to diagnose in pregnancy due to a physiological dilatation of the renal tract. Radiological assessment and intervention to the renal tract in pregnancy are also discussed in this chapter.

scholarly journals Severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP syndrome and acute kidney injury following SARS-CoV-2 infection

2020 ◽  
Vol 13 (8) ◽  
pp. e237521 ◽  
Author(s):  
Irshad Ahmed ◽  
Nashwa Eltaweel ◽  
Lina Antoun ◽  
Anoop Rehal
Keyword(s):  
Acute Kidney Injury ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Kidney Injury ◽  
Team Approach ◽  
Diagnostic Dilemma ◽  
First Case ◽  
Elevated Liver Enzymes ◽  
Acute Fatty Liver

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has presented many diagnostic challenges and uncertainties. Little is known about common pathologies complicating pregnancy and how their behaviour is modified by the presence of SARS-CoV-2. Pregnancy itself can alter the body’s response to viral infection, which can cause more severe symptoms. We report the first case of a patient affected with sudden-onset severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP (haemolysis, elevated liver enzymes and low platelet) syndrome and acute kidney injury following SARS-CoV-2 infection. Although an initial diagnostic dilemma, a multidisciplinary team approach was required to ensure a favourable outcome for both the mother and the baby. Our case report highlights the need for health professionals caring for pregnant women to be aware of the complex interplay between SARS-CoV-2 infection and hypertensive disorders of pregnancy.

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