scholarly journals Triad of Idiopathic Thrombocytopenic Purpura, Preeclampsia, and HELLP Syndrome in a Parturient: A Rare Confrontation to the Anesthetist

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Tanu Mehta ◽  
Geeta P. Parikh ◽  
Veena R. Shah
Keyword(s):  
Caesarean Section ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Liver Enzymes ◽  
Rare Complication ◽  
Anesthetic Management ◽  
Emergency Caesarean Section ◽  
Pregnancy Induced Hypertension ◽  
Thrombocytopenic Purpura ◽  
Elevated Liver Enzymes ◽  
Induced Hypertension

Idiopathic thrombocytopenic purpura (ITP) with HELLP represents a rare complication that requires combined care of obstetrician, anesthesiologist, hematologist, and neonatologist. At 37-week gestation a 35-year-old parturient (G2A1P0) a known case of chronic ITP presented with severe pregnancy induced hypertension (PIH), thrombocytopenia, and elevated liver enzymes. We describe successful anesthetic management of this patient who was taken for emergency caesarean section.

scholarly journals How to evaluate and treat the spectrum of TMA syndromes in pregnancy

Hematology ◽  
2021 ◽  
Vol 2021 (1) ◽  
pp. 545-551
Author(s):  
Marie Scully
Keyword(s):  
Multidisciplinary Approach ◽  
Liver Enzymes ◽  
Organ Damage ◽  
Pregnancy Induced Hypertension ◽  
Fetal Outcomes ◽  
Treatment Pathway ◽  
Elevated Liver Enzymes ◽  
Induced Hypertension ◽  
Uremic Syndrome ◽  
In Pregnancy

Abstract Thrombotic microangiopathy (TMA) is the broad definition for thrombocytopenia, microangiopathic hemolytic anemia, and end-organ damage. Two important categories are thrombotic thrombocytopenic purpura (TTP) and complement-mediated hemolytic-uremic syndrome (CM-HUS). Pregnancy and the immediate postpartum period are associated with TMAs specific to pregnancy in rare situations. These include pregnancy-induced hypertension, preeclampsia, and hemolysis, elevated liver enzymes, and low platelets. TTP and CM-HUS may present in pregnancy. However, the diagnosis may not be immediately obvious as they share characteristics of pregnancy-related TMAs. Within this review, we discuss investigations, differential diagnosis of TMAs in pregnancy, and management. The importance is a risk of maternal mortality but also poor fetal outcomes in relation to TTP and CM-HUS. Treatment of these disorders at presentation in pregnancy is discussed to achieve remission and prolong fetal viability if possible. In subsequent pregnancies, a treatment pathway is presented that has been associated with successful maternal and fetal outcomes. Critical to this is a multidisciplinary approach involving obstetricians, the fetal medicine unit, and neonatologists.

scholarly journals Perioperative Management of Intra-Partum Seizure

1997 ◽  
Vol 25 (5) ◽  
pp. 535-538 ◽  
Author(s):  
A. Y. Cheng ◽  
A. Kwan
Keyword(s):  
Blood Pressure ◽  
Differential Diagnosis ◽  
Caesarean Section ◽  
Intracranial Haemorrhage ◽  
Perioperative Management ◽  
Emergency Caesarean Section ◽  
Cerebrovascular Event ◽  
Pregnancy Induced Hypertension ◽  
Induced Hypertension ◽  
Neurosurgical Intervention

A young nulliparous woman previously diagnosed with pregnancy-induced hypertension suffered a seizure during active first stage labour. Pre-seizure blood pressure was borderline high but she did not fulfill other criteria for pre-eclampsia. She underwent emergency caesarean section for presumed eclampsia. Postoperatively, she deteriorated neurologically. CT scan showed an intracranial haemorrhage requiring neurosurgical intervention. The similarities of presentation of a primary cerebrovascular event and eclampsia following an intra-partum seizure made the differential diagnosis difficult.

MATERNOFETAL OUTCOME IN MECONIUM STAINED LIQUOR AT TERTIARY CARE HOSPITAL

2021 ◽  
pp. 48-50
Author(s):  
Neha Agarwal ◽  
Samta Bali Rathore ◽  
Shivani Baberwal-
Keyword(s):  
Caesarean Section ◽  
Perinatal Asphyxia ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Birth Asphyxia ◽  
Meconium Aspiration Syndrome ◽  
Care Hospital ◽  
Pregnancy Induced Hypertension ◽  
Meconium Aspiration ◽  
Induced Hypertension

BACKGROUND: Occurance of meconium-stained amniotic uid (MSAF) during labour may be considered as a measure for prediction of poor fetal outcomes such as meconium aspiration syndrome and perinatal asphyxia ,resulting in perinatal as well as neonatal morbidity and mortality. It constitutes about 5% of deliveries with meconium stained amniotic uid and death results in about 12% of infants with MAS. METHODS: 40 cases of meconium stained liquor detected after spontaneous or artical rupture of membranes taken during labour from june 2020 to december 2020 and their outcome in terms of mode of delivery(whether vaginal delivery or lower segment caesarean section) and fetal outcome and associated maternal high risk were studied RESULT: Anemia was co existant in around 15%, pregnancy induced hypertension(PIH) in 25%and premature rupture of membrane in 10%.Pregnancies complicated with Pregnancy induced hypertension had signicant higher rate of meconium stained liquor among all cases. Caesarean Section was commonly performed in meconium stained amniotic uid cases and accounted for about 65%of all cases. CONCLUSIONS: Meconium Stained amniotic uid increases the chances of caesarean rates,leading to birth asphyxia ,Meconium Aspiration Syndrome and hence increases the chances of neonatal intensive unit admission.

scholarly journals A Case of Massive Hepatic Infarction in a Patient with HELLP Syndrome

2019 ◽  
Vol 09 (01) ◽  
pp. e84-e87
Author(s):  
Jessica Morgan ◽  
Micaela Della Torre ◽  
Anna Whelan ◽  
Sophia Rodriguez ◽  
Laura DiGiovanni
Keyword(s):  
Liver Enzymes ◽  
Epigastric Pain ◽  
Early Recognition ◽  
Rare Complication ◽  
Liver Function Tests ◽  
True Incidence ◽  
Hepatic Infarction ◽  
Elevated Liver Enzymes ◽  
Blood Pressures ◽  
The Right

Background Hepatic infarction is an exceedingly rare complication of hemolysis, elevated liver enzymes, and low platelets syndrome. Few cases have been described in the medical literature and the true incidence remains unknown. It can lead to fulminant liver failure, liver transplant, or death if not promptly addressed. Case Report A 22-year-old primigravida presented with right upper quadrant and epigastric pain at 28 weeks' gestation. She had severely elevated blood pressures requiring intravenous antihypertensives as well as proteinuria, thrombocytopenia, and mild transaminitis. Within 6 hours of admission, her rapidly rising liver function tests (LFTs) necessitated urgent delivery by primary cesarean section. Her liver enzymes continued to rapidly worsen postoperatively and immediate postpartum computed tomography of the abdomen and pelvis revealed massive hepatic infarction, 11 × 10 × 15 cm, of the right lobe of the liver. Her transaminases peaked at alanine transferase of 2,863 IU/L and aspartate transferase of 2,732 IU/L. She received supportive multidisciplinary intensive care, and LFTs returned to normal by postoperative day 20. Conclusion Hepatic infarction is an extraordinarily rare complication of pre-eclampsia. Early recognition and prompt multidisciplinary management are vital to prevent catastrophic bleeding, hepatic failure, and death.

scholarly journals Ruptured subcapsular hepatic hematoma complicating severe preeclampsia with haemolysis, elevated liver enzymes, low platelet count syndrome: a case report

2020 ◽  
Vol 9 (11) ◽  
pp. 4726
Author(s):  
Ashok R. Anand ◽  
Binita H. Shah ◽  
Pratibha Vashisth
Keyword(s):  
Hellp Syndrome ◽  
Liver Enzymes ◽  
Rare Complication ◽  
Treatment Options ◽  
Severe Preeclampsia ◽  
Medical Support ◽  
Artery Ligation ◽  
Hepatic Hematoma ◽  
Elevated Liver Enzymes ◽  
Low Platelet Count

Subcapsular liver hematoma is rare complication of severe preeclampsia and HELLP syndrome, thus making it essential for these patients to be followed up in critical and intensive care units for advanced medical support with fluid and electrolyte management and replacement of blood products while treating underlying disorders. Treatment options have to be individualised and vary from conservative management to surgical treatment including hepatic resection, hepatic artery ligation, and liver transplantation. In this paper we report a case of ruptured hepatic hematoma in a 35 year old female, few hours within delivery, a complication of severe preeclampsia and HELLP syndrome

scholarly journals Liver disease in children and Adolescents with Type1 Diabetes Mellitus

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M H Elsayed ◽  
M T Hamza ◽  
M M Elsaeed ◽  
R A F Thabet
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Liver Disease ◽  
Type 1 Diabetes Mellitus ◽  
Children And Adolescents ◽  
Liver Enzymes ◽  
Rare Complication ◽  
Elevated Liver Enzymes ◽  
Liver Transaminases

Abstract Glycogenic hepatopathy (GH) is a very rare complication seen mostly in patients with type 1 diabetes mellitus (T1DM) in whom glycemic control has been poor for a long time. We assessed liver diseases in children and adolescents with type 1 diabetes mellitus by detection of elevated liver transaminases and confirmed by fibro scan and ultrasound. One hundred and seven children and adolescents with T1DM were subjected to detailed history, physical examination, laboratory investigation and radiological investigation. Liver transaminases, mean HbA1c and pelviabdominal ultrasound were done for all patients while fibro scan for those with elevated liver enzymes only. Patients with elevated liver enzymes were reassessed after one year. Only nine of our patients have elevated liver enzymes. HbA1c and fibro scan abnormalities (F stage) were significantly higher in patients with elevated liver enzymes. (p < 0.001) After follow up a significant decrease in liver enzymes, fibro scan abnormalities and HbA1c in the group with elevated liver enzymes initially was detected. (p < 0.001) We concluded that liver disease is not a common complication in patients with long standing uncontrolled diabetes which can be reversed after proper control.

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