Pregnancy-Associated Hemolysis, Elevated Liver Functions, Low Platelets (HELLP) Syndrome: An Obstetric Disease in the Intensive Care Unit

1996 ◽  
Vol 11 (3) ◽  
pp. 173-178
Author(s):  
George Gilson ◽  
Pamela Golden ◽  
Luis Izquierdo ◽  
Luis Curet
Keyword(s):  
Perinatal Mortality ◽  
Hellp Syndrome ◽  
Medical Condition ◽  
Epigastric Pain ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Maternal Complications ◽  
Diagnostic Features ◽  
Clinical Series ◽  
Liver Functions

We reviewed the experience with hemolysis, elevated liver functions, low platelets (HELLP) syndrome at the University of New Mexico Hospital over the past 10 years to delineate the epidemiology and the clinical course of the disease. A retrospective chart review of a large, university-based, largely indigent, pregnant population was undertaken with attention to diagnostic features of the syndrome and maternal and infant outcomes of affected pregnancies. Comparisons were made with other large reported clinical series. Preeclampsia complicated 5.6% of deliveries in this study, and the HELLP syndrome occurred in 116 patients (0.3% of all deliveries). Epigastric pain, nausea, vomiting, and malaise usually heralded the syndrome. Signs and symptoms of preeclampsia (e.g., hypertension, proteinuria, and edema) were most often not striking at the time of presentation. The mean platelet count at diagnosis was 60 ± 25 × 103. Initial signs of hemolysis were usually minimal, although the hematocrit decreased a mean of 11.5 ± 5 vol% over the course of the disease. Moderate elevations of hepatic enzyme levels, specifically lactic dehydrogenase, were common; hyperbilirubinemia was usually mild and late. Maternal complications included disseminated intravascular coagulation, eclampsia, pulmonary edema, adult respiratory distress syndrome, and hepatic hematoma. Eight stillbirths and 7 neonatal deaths occurred (perinatal mortality, 126/1,000). HELLP syndrome is a relatively infrequent but serious development in the evolution of preeclampsia/eclampsia. Variations in onset and severity of hemolysis, hepatic dysfunction, and thrombocytopenia are common. Maternal complications and the perinatal mortality rate are high. Pregnant patients with right upper quadrant or epigastric pain and thrombocytopenia, even in the absence of significant hypertension and proteinuria, are most likely to have HELLP syndrome, rather than some other medical condition. Awareness of the variable presentations of this syndrome permit the prompt recognition and management necessary to optimize maternal and neonatal outcomes.

scholarly journals SÍNDROME HELLP: A CONDUTA OBSTÉTRICA E SUAS CONTROVÉRSIAS

2018 ◽  
Vol 5 (3) ◽  
pp. 75-78
Author(s):  
Flávia da Silva Oliveira ◽  
Fábio Roberto Ruiz de Moraes
Keyword(s):  
Conservative Treatment ◽  
Perinatal Mortality ◽  
Hellp Syndrome ◽  
Liver Enzymes ◽  
Signs And Symptoms ◽  
Clinical Entity ◽  
Morbidity And Mortality ◽  
General Malaise ◽  
Elevated Liver Enzymes ◽  
Mortalidade Materna

RESUMO A síndrome HELLP pode ocorrer na pré-eclâmpsia (PE) ou na eclampsia e se caracteriza pelo conjunto de sinais e sintomas associados à hemólise microangiopática, elevação de enzimas hepáticas e plaquetopenia, podendo afetar 0,6% das gestações e 4-12% das pacientes com PE grave. Responsável por elevados índices de mortalidade materna e perinatal, a paciente pode apresentar-se com mal estar geral, epigastralgia, dor em hipocôndrio direito, náuseas ou vômitos, cefaléia, escotomas, associados a quadro hipertensivo e proteinúria. A conduta obstétrica na Síndrome HELLP ainda apresenta controvérsias na literatura, principalmente quando estamos diante de gestações em estágio inicial. Existem condutas favoráveis ao tratamento conservador no intuito de estabilizar a progressão da doença e reduzir a morbidade e mortalidade da mãe e do feto. Outras que postergam a interrupção da gestação por período de 48 horas nos menores de 34 semanas. E ainda temos condutas obstétricas que adotam a interrupção de emergência, independente da idade gestacional.   Palavras-chave: Síndrome HELLP, Pré-eclâmpsia grave, Eclâmpsia, gestação de alto risco. ABSTRACT HELLP syndrome is a clinical entity that can occur in pre-eclampsia or eclampsia and is characterized by presenting a set of signs and symptoms associated with mircroangiopathic hemolysis, raised elevated liver enzymes and thrombocytopenia, which may affect 0.6% of pregnancies and 4-12% of patients with severe PE. Responsible for high rates of maternal and perinatal mortality, the patient may present with general malaise, epigastralgia, right hypochondrium pain, nausea or vomiting, headache, scotomas, associated with hypertension and proteinuria. The obstetric behavior in HELLP syndrome is still controversial in the literature, especially when we are in the early stages of pregnancy. It was observed that some authors favor conservative treatment in order to stabilize the progression of the disease and reduce morbidity and mortality of the mother and the fetus. However, other authors take the course of postponing gestation of less than 34 weeks per 48-hour period. And we still have obstetric behaviors that adopt the emergency interruption, regardless of gestational.

scholarly journals Feto maternal outcome in eclampsia after 28 weeks of pregnancy: vaginal delivery versus caesarean section

2017 ◽  
Vol 6 (9) ◽  
pp. 3875
Author(s):  
Bhawna Madan
Keyword(s):  
Caesarean Section ◽  
Perinatal Mortality ◽  
Vaginal Delivery ◽  
Mode Of Delivery ◽  
Signs And Symptoms ◽  
Fetal Outcome ◽  
Maternal Complications ◽  
Maternal Deaths ◽  
Neonatal Deaths ◽  
Still Births

Background: Eclampsia is the occurrence of convulsions or coma unrelated to other cerebral condition with signs and symptoms of preeclampsia. Objective of present study was the comparison of maternal and fetal outcome of women with more than 28 weeks gestation complicated by antepartum eclampsia when terminated either by caesarean section or by vaginal delivery.Methods: 200 Women with more than 28 weeks of gestation with antepartum eclampsia were studied from admission to discharge or death. Depending upon the mode of delivery, they were divided into two groups: C.D. group. Where caesarean section was performed and V.D. group, where vaginal delivery was carried out. Maternal and Perinatal outcome were studied in the two groups and compared.Results: Of the 200 cases, caesarean section was done in 40% of the cases, while vaginal delivery was carried out in 60%. Maternal complications were seen in 15% of the cases in the C.D group and 60% of the cases in the V.D. group. Maternal deaths occurred in none of the case in the C.D group and in 33% of the cases in the V.D group. The incidence of live births, still births and neonatal deaths was 87.8%, 2.43% and 9.75% respectively in the C.D group, while it was 49.16%, 45.16% and 9.67% in the V.D group The Corrected perinatal mortality was 9.75% in the C.D group and 43.55% in the V.D group. Apgar score less than 5 at l minute was seen in 35% cases in the C.D group and 82.35% cases in the V.D group.30% of the cases in the C.D group and 76.47% of the cases in the V.D group required NICU admission.Conclusions: Timely caesarean section reduces maternal and Perinatal mortality and improves their outcome in antepartum eclampsia, especially in women with more than 28 weeks of pregnancy.

scholarly journals 526. Clinical Presenting Characteristics of Pediatric COVID-19 Infection in a Tertiary Care Children’s Hospital in Detroit

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S330-S330
Author(s):  
Jocelyn Y Ang ◽  
Nirupama Kannikeswaran ◽  
Basim Asmar
Keyword(s):  
Mechanical Ventilation ◽  
Severe Disease ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Pediatric Emergency ◽  
Study Cohort ◽  
Mild Disease ◽  
Presenting Symptoms ◽  
Patient Disposition

Abstract Background There is limited data regarding the presenting clinical characteristics of COVID-19 in children. Our objective is to describe the clinical presentations and outcomes of COVID-19 infection early in the pandemic at our institution. Methods We performed a retrospective chart review of children up to 18 years who underwent testing for SARS CoV-2 from March 1st to May 10th 2020 at our pediatric emergency department. We abstracted patient’s demographics, clinical presentation, diagnostic studies and patient disposition. We classified the severity of clinical illness based on published criteria. We excluded patients diagnosed with Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. Results SARS CoV-2 testing was performed on 481 patients of whom 43 (8.9%) tested positive. Of these, 4 were diagnosed with MIS-C. Data of 39 patients were analyzed. Patients’ demographics, co-morbidities, presenting signs and symptoms and disposition are shown in Table 1. Age range was 47 days – 18 years. Infants representing one third (14/39; 35.9%) of our study cohort. There was equal sex distribution. Asthma or obesity was present in 17 (44%). The most common presenting symptoms included fever, cough, shortness of breath and diarrhea. Chest radiograph showed pneumonia in 12 (30.8%) patients. Two thirds (27/39; 69.2%) were asymptomatic or had mild disease; six patients (15.4%) had severe or critical illness (Figure 1). Nineteen (48%) patients were admitted to the general pediatric service. Eleven (28%) were admitted to the Intensive Care Units (ICU). The characteristics, presenting symptoms and interventions performed in the PICU cohort are shown in Table 2. Half of these patients required mechanical ventilation. There was one death in a 3 month old infant unrelated to SARS CoV-2. Majority of the infants required hospitalization (12/14; 85.7%), including 4 to the PICU (one each for non accidental trauma, ingestion, seizure and pneumonia). Table 1. Patient demographics, signs and symptoms of COVID-19 infection in Children Table 2: PICU patients: Characteristics, Interventions and pharmacotherapy Figure 1: Severity of Ill ness in the study cohort Conclusion Majority (17; 43%) of our children with COVID-19 had a mild disease. Eleven (28%) including 4 infants required critical care; 5 required mechanical ventilation. There was no COVID-19 related mortality. Larger studies are needed to further define the spectrum of COVID- 19 and risk factors associated with severe disease in children. Disclosures All Authors: No reported disclosures

scholarly journals Applications of Medical Tattooing: A Systematic Review of Patient Satisfaction Outcomes and Emerging Trends

2021 ◽  
Author(s):  
Stacie J Becker ◽  
Jeffrey E Cassisi
Keyword(s):  
Patient Satisfaction ◽  
Medical Condition ◽  
Case Series ◽  
Outcome Data ◽  
Future Research ◽  
Health Service Provider ◽  
Level Of Evidence ◽  
Case Examples ◽  
Areola Complex ◽  
Clinical Series

Abstract Background Medical tattooing is often applied in the context of plastic, aesthetic, and reconstructive surgery to help achieve the best cosmetic outcome. Objectives This article reviews various conditions that medical tattooing have been empirically studied in terms of patient satisfaction outcomes; makes practice recommendations; and suggests future directions for research. Methods This review was performed following the PRISMA guidelines. Studies were included if the tattooing application was associated with a medical condition and if outcome data was provided using at least a case series methodology. Where no cohort or clinical series exist, case examples are used from the literature and the author’s practice to illustrate emerging medical tattooing applications that need further evaluation. Results Eighteen studies met the inclusion criteria and were applied to the following conditions: baldness, vitiligo, scars from incisions, lacerations or burns, and nipple areola complex reconstruction following breast surgery. Conclusions The application of medical tattooing has shown high levels of patient satisfaction across various conditions. The practice recommendation grade is “B” or recommend since the level of evidence for these interventions ranged from III to IV according to the ASPS guidelines. This means clinicians can consider this treatment alternative, but they should be alert to new information and be sensitive to patient preferences. Recommendations are made for reporting future research including clearly describing procedural details, identifying the professional performing the procedure, increased use of standardized outcome measures, and that satisfaction ratings be assessed by someone independent of the health service provider. Further research using RCT methodology with waitlist controls is needed.

Invasive Fungal Sinusitis following Liver or Bone Marrow Transplantation

1994 ◽  
Vol 8 (2) ◽  
pp. 77-84 ◽  
Author(s):  
Perry J. Johnson ◽  
William M. Lydiatt ◽  
James V. Huerter ◽  
Frederic P. Ogren ◽  
Julie M. Vose ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Marrow Transplantation ◽  
Effective Means ◽  
Management Strategies ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Fungal Sinusitis ◽  
Hematopoietic Growth Factors ◽  
Invasive Fungal Sinusitis

Invasive fungal infection of the nose and paranasal sinuses occurs almost exclusively in immunocompromised patients and is increasingly recognized as a complication of organ transplantation. We performed a retrospective chart review of 955 bone marrow and 749 liver transplant patients to identify risk factors, presenting signs and symptoms, methods of diagnosis, and successful management strategies. We report on five cases following bone marrow transplantation and one case following liver transplantation. Neutropenia is the single most important risk factor in the development of and recovery from invasive fungal sinusitis. Early diagnosis, combined with antifungal agents, hematopoietic growth factors, and aggressive surgical debridement is the most effective means of management.

scholarly journals Incidence, characteristics, maternal complications, and perinatal outcomes associated with preeclampsia with severe features and HELLP syndrome

2018 ◽  
Vol Volume 10 ◽  
pp. 371-377 ◽  
Author(s):  
Kiattisak Kongwattanakul ◽  
Piyamas Saksiriwuttho ◽  
Sukanya Chaiyarach ◽  
Kaewjai Thepsuthammarat
Keyword(s):  
Hellp Syndrome ◽  
Perinatal Outcomes ◽  
Maternal Complications

scholarly journals Periodontal intervention effects on pregnancy outcomes in women with preeclampsia.

1969 ◽  
Vol 40 (2) ◽  
pp. 177-184
Author(s):  
Julián A. Herrera ◽  
Santiago Vélez Medina ◽  
Rodolfo Molano ◽  
Virna Medina ◽  
Javier E. Botero ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Hellp Syndrome ◽  
Severe Preeclampsia ◽  
Maternal Complications ◽  
Frequent Finding ◽  
Mild Preeclampsia ◽  
Social Demographic ◽  
Study Inclusion ◽  
Clinical Stability

Objective: To determine the efficacy of periodontal intervention on pregnancy outcome in mild preeclamptic women. Methods: A sample of 60 pregnant women with mild preeclampsia (blood pressure levels < 160/110 mm and proteinuria >300 mg/l in 24 hours urine) from the Hospital Universitario del Valle (Cali, Colombia) was included to the study. Preeclamptic women were randomized in two groups, one with periodontal intervention (PIG, N=28) and another in which the periodontal intervention was practiced after childbirth (NPIG, N=32). Maternal socio-demographic, medical and periodontal data were obtained. PIG included patients in which supragingival and subgingival cleaning within ultrasonic and manual devices were performed after study inclusion. The progression from mild to severe preeclampsia, eclampsia or HELLP syndrome, the number of days of clinical stability and the percentile of birth-weight adjusted for gestational age were evaluated in both groups. Results: Most of the patients (60%) were multigravids. Gestational age at inclusion was 31.8±1.6 weeks. Chronic periodontitis was a frequent finding (61.7%). Social, demographic, medical and periodontal conditions were similar between both groups. Disease progression to severe preeclampsia, eclampsia or HELLP syndrome was also similar (89.2% PIG versus 84.4%, p=0.65) (OR=1.06 IC 95% 0.87-1.29, p=0.65). Days of clinical stability were similar between the groups (median 10 days , range 1-46, PIG versus 12 days, range 1-59, p=0.57) and the percentile of birth weight adjusted with gestational age had no differences between the groups (median percentil 50 range 5-90 PIG versus percentil 55 range 5-95, p=0.73). Conclusion: Periodontal intervention does not seem to harm the health, the severity or alter the frequency on maternal complications in mild preeclampsia subjects.

scholarly journals Pregnancy onset congenital thrombotic thrombocytopenic purpura (Upshaw-Schulman syndrome) mimicking HELLP syndrome: a case report

2021 ◽  
Vol 29 (3) ◽  
pp. 270-273
Author(s):  
Başak Ergin ◽  
Berna Buse Kobal ◽  
Zeynep Yazıcı ◽  
Ali Hakan Kaya ◽  
Sezin Canbek ◽  
...  
Keyword(s):  
Thrombotic Thrombocytopenic Purpura ◽  
Hellp Syndrome ◽  
Epigastric Pain ◽  
Novel Mutation ◽  
Adamts13 Activity ◽  
Thrombotic Microangiopathies ◽  
Thrombocytopenic Purpura ◽  
Uremic Syndrome ◽  
Congenital Thrombotic Thrombocytopenic Purpura ◽  
Low Platelet Count

Objective Thrombotic thrombocytopenic purpura is a thrombotic microangiopathic condition characterized by hemolytic anemia, thrombocytopenia, neurologic abnormalities, fever and renal dysfunction. Thrombotic microangiopathies such as preeclampsia and HELLP syndrome are pregnancy-specific, whereas others such as thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome are not. In this report, we present a case at which we identified a novel mutation which led to a significant reduction of ADAMTS13 activity. Case(s) A nulliparous pregnant woman of 32-year-old presenting with epigastric pain, hypertension and low platelet count was first suspected of HELLP syndrome, but was diagnosed with congenital TTP after delivery. Conclusion HELLP syndrome co-existed with undiagnosed TTP in this case. We strive to have sufficient awareness in order to distinguish these two pathologies from each other on an antenatal basis, because the causes of the managements are entirely different.

scholarly journals A CASE STUDY ON AYURVEDIC MANAGEMENT OF VATAHATA VARTMA (PTOSIS)

2021 ◽  
Vol p5 (4) ◽  
pp. 2955-2959
Author(s):  
Sangeeta Neelannavar ◽  
Vijayamahantesh Hugar ◽  
Varsha Kulkarni
Keyword(s):  
Surgical Intervention ◽  
Medical Condition ◽  
Medical Science ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Upper Eyelid ◽  
Contemporary Science ◽  
Functional Deterioration

Vatahata Vartma is a condition of Vartma where in the Vartma-Shuklagata Sandhi is afflicted by vitiated Vata leading to Vimukta Sandhi (functional deterioration of the Shuklavartmagata Sandhi which facilitates the movement of eyelids), Nischeshta (no or reduced eyelids activity), Nimilayati (unable to close the eyelids). The signs and symptoms of Vatahata Vartma can be corelated to Ptosis in modern medical science. Ptosis is a medical condition in which there will be drooping or falling of upper eyelid. The condition worsens when there is exhaustion of the extra ocular muscles. This condition can be either uni-ocular or binocular. If the condition is left untreated, it can lead to complications. Surgical intervention is the only line of treatment mentioned for ptosis in contemporary science. Ayurveda has mentioned different treatment modalities for similar conditions. This paper highlights a case study of Vatahata Vartma (ptosis) managed with Ayurvedic line of treatment with Mukhabhyanga, Sweda, Nasya, Akshipindi and Akshi Tarpana. Keywords: Vatahata Vartma, Ptosis, Nasya, Akshitarpana, Akshipindi

scholarly journals Maternal and perinatal outcome in patients with severe pre eclampsia/ eclampsia with and without HELLP syndrome

2014 ◽  
Vol 1 (4) ◽  
pp. 7-12
Author(s):  
T Gupta ◽  
N Gupta ◽  
J Jain ◽  
S Gupta ◽  
P Bhatia ◽  
...  
Keyword(s):  
Birth Weight ◽  
Hellp Syndrome ◽  
Perinatal Outcome ◽  
P Value ◽  
Maternal Complications ◽  
Singleton Pregnancy ◽  
Prospective Longitudinal Study ◽  
Entire Study ◽  
Group 3 ◽  
Prospective Longitudinal

OBJECTIVE: To evaluate the occurrence of HELLP syndrome inpatients with severe pre eclampsia & eclampsia and to compare the maternal & perinatal outcome in patients with and without HELLP syndrome (partial and true). METHOD: This was a prospective longitudinal study conducted in the Department of Obstetrics & Gynaecology, E.S.I. PGIMSR,NewDelhi from August 2011-April 2013. 50 pregnant women with singleton pregnancy with severe pre eclampsia detected at 28 or more weeks of gestation were enrolled. Patients were divided into three groups: group 1 with severe pre eclampsia, group 2 with severe pre eclampsia with partial HELLP syndrome and group 3 with severe pre eclampsia with true HELLP syndrome. Patients in three groups were compared in regard to maternal complications, gestational age atdelivery, mode ofdelivery, hospital stay andperinatal outcome. RESULTS: Prevalence of HELLP syndrome in severe pre eclampsia was 40% (partial HELLP= 28% and true= 12%). Antenatal and maternal complications were more in true HELLP syndrome patients as compared to other groups. PPH was observed in 40% of entire study group. DIC was found more in true HELLP syndrome patient with high statistically significant p value<0.001 Blood and its product transfusion was more in true HELLP syndrome. There was 100% ICU admission in group 3. In severe pre eclampsia, 11 neonates had birth weight >2.5kg. Where as in partial and true HELLP syndrome, no neonate had birth weight more than 2.5kg.This difference was statistically significant. There was 100% NICU admission in HELLP syndrome, 91.66% in partial HELLP syndrome and 42.3% in severe preeclampsia. The perinatal morbidity and mortality was higher in HELLP syndrome patients than in patient with severe pre eclampsia without HELLP syndrome. CONCLUSION: The study concludes that both maternal and perinatal outcome were adverse in HELLP syndrome than in severe pre eclampsia without HELLP syndrome. DOI: http://dx.doi.org/10.3126/jucms.v1i4.9564 Journal of Universal College of Medical Sciences (2013) Vol.1 No.04: 7-12

Sign in / Sign up

Export Citation Format

Share Document