Surgical prophylaxis of bleeding during an the operative delivery in a patient with HELLP syndrome

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Andrei V. Murashko ◽  
Margarita G. Sonich ◽  
Yana Y. Sulina ◽  
Sergei A. Timofeev ◽  
Anatoliy I. Ischenko
Keyword(s):  
Hellp Syndrome ◽  
Multiple Pregnancy ◽  
Perinatal Morbidity ◽  
Reduce Blood Loss ◽  
Surgical Prophylaxis ◽  
Case Presentation ◽  
Time Period ◽  
Close Time ◽  
Multicenter Clinical Trials ◽  
Preterm Newborns

Abstract Background HELLP-syndrome is rare, but it causes serious pregnancy complications with significantly increased maternal and perinatal morbidity and mortality. To date there is no agreement on its pathophysiology. The only treatment is an emergent delivery, which in turn increases the number of preterm newborns and does not always improve the patient’s condition in a close-time period with a high-risk of postpartum bleeding. To reduce the risk of uterine bleeding in this group of patients, we proposed to use a preventive application of compression sutures to the uterus during surgical delivery. Case presentation The management of HELLP syndrome in a pregnant woman with a multiple pregnancy (twins) at 34 weeks’ gestation with a favorable outcome is presented. Compression sutures: the B-Lynch and two circular sutures were applied to the uterus to prevent bleeding. Conclusion HELLP syndrome is a dangerous, sudden and rapidly progressive complication that threatens the life of the mother and fetus. Appliance of preventive compression sutures could reduce blood loss. However, for a wider use of the method, multicenter clinical trials are needed.

Delayed interval delivery of the second and third fetuses in multiple pregnancy triplet (Сase report)

2016 ◽  
pp. 148-152
Author(s):  
Y. Dubossarskaya ◽  
◽  
L. Padalko ◽  
L. Zakharchenko ◽  
E. Savel’eva ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Multiple Pregnancy ◽  
Bed Rest ◽  
Perinatal Morbidity ◽  
Perinatal Complications ◽  
Triplet Pregnancy ◽  
Satisfactory Condition ◽  
Nulliparous Women ◽  
Perinatal Center ◽  
Delayed Interval Delivery

This article describes a clinical case of vaginal delivery in nulliparous women 24 years old delayed interval delivery of the second and third fetuses in spontaneous multiple pregnancy dichorionic triamniotic triplet in a tertiary perinatal center. After preterm delivery in 27+5 weeks of gestation the first fetus to reduce perinatal morbidity and mortality of two fetuses that are left in the uterus, with informed consent of the woman preterm delivery the second and third fetuses occurred at intervals of 38 days, in 33+1 weeks of gestation. Careful monitoring of the state of the mother and fetuses was conducted. To increase the interval between the birth of the first fetus and the second and the third fetuses, prevention of obstetric and perinatal complications used tocolysis, antibiotics, progesterone, the prevention of respiratory distress syndrome of the newborn by corticosteroids and bed rest. Three girls were born alive with a weight of 980, 1800 and 1950 grams correspondingly. Childbirth complicated second degree perineal laceration and retained portions of placenta and membranes, puerperal period was uneventful. After 1.5 months, all infants discharged with her mother in a satisfactory condition with a weight of more than 3000 grams. Key words: multiple pregnancy, triplet pregnancy, delayed interval delivery in triplet pregnancy, preterm delivery.

scholarly journals A study of maternal and perinatal outcome in cases of HELLP and partial HELLP syndrome

2017 ◽  
Vol 6 (12) ◽  
pp. 5491 ◽  
Author(s):  
Kanchan Durugkar
Keyword(s):  
Prospective Study ◽  
Hellp Syndrome ◽  
Perinatal Outcome ◽  
Liver Enzymes ◽  
Severe Preeclampsia ◽  
Perinatal Morbidity ◽  
Elevated Liver Enzymes ◽  
Low Platelet Count ◽  
Laboratory Investigations ◽  
In Pregnancy

Background: The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10-20% of cases with severe preeclampsia. The objective of the present prospective study is to study on incidence, diagnosis, and variable presentations of HELLP syndrome in preeclampsia to analyse the severity and complications, as it is associated with maternal, perinatal morbidity and mortality. HELLP syndrome is difficult to diagnose when it presents with atypical clinical features.Methods: In the prospective study of 300 admitted cases with more than 20 weeks of gestation, were having preeclampsia. The selected cases were analyzed clinically with relevant history, clinical data and detailed laboratory investigations made for better analyses of complications and outcome in HELLP syndrome.Results: Under further clinical diagnosis of 300 cases of preeclampsia, 34 cases (11.33%) were of HELLP Syndrome and 44 (14.66%) cases were of partial HELLP syndrome. The present study shows 2.9% maternal mortality in HELLP and 4.5% in partial HELLP syndrome. Perinatal mortality was 17.6% with HELLP and 25% with partial HELLP.Conclusions: The diagnosis of HELLP syndrome has been made as a severe variant and complication of severe preeclampsia and eclampsia. It needs early diagnosis, timely intervention to arrest further progress and complications like multi organ dysfunction, renal failure, DIC, abruption etc and to improve maternal and perinatal outcome.

scholarly journals Obstetric and perinatal outcome of twin pregnancy: a prospective study in a tertiary care hospital in North India

2018 ◽  
Vol 7 (6) ◽  
pp. 2455
Author(s):  
Shivali Bhalla ◽  
Seema Grover Bhatti ◽  
Shalini Devgan
Keyword(s):  
Gestational Age ◽  
Perinatal Outcome ◽  
Twin Pregnancy ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
North India ◽  
Care Hospital ◽  
Perinatal Morbidity

Background: Multiple pregnancy constitutes an important portion of high risk pregnancies and is a matter of grave concern to obstetricians and paediatricians owing to maternal and perinatal morbidity and mortality associated to it. Objective of present study was to evaluate maternal and perinatal outcome of twin pregnancy.Methods: This observational study included 50 women with twin pregnancy with gestational age of 26 weeks or more. Maternal and perinatal outcomes were studied.Results: The incidence of twin pregnancy was 2.8 % with maximum incidence in age group of 20 -29 years and in multigravida. Mean gestational age was 34.2 weeks. Vertex - vertex fetal presentation was most common presentation. Most frequent mode of delivery was ceserean section (54%). Preterm labour was most common maternal complication (74%), followed by anaemia (62%). Complications in perinatal period were birth hypoxia (58 %), intrauterine growth restriction (15 %), hyper-bilirubinemia (11%) and neonatal sepsis (10 %). 88% of the newborns were LBW. Perinatal mortality in our study was 17%.Conclusions: Twin pregnancies are associated with significant maternal and perinatal morbidity which is more so for second twin. Effective antenatal care planned delivery and good pediatric facilities help decrease the complications. Managment of twin pregnancy requires multidisciplinary approach and involvement of skilled obstetricians and paediatricians.

scholarly journals Never too late? - Quadruplets at the age of 65 years

2021 ◽  
Author(s):  
Larry Hinkson ◽  
Christof Dame ◽  
Thorsten Braun ◽  
Irit Nachtigall ◽  
Wolfgang Henrich
Keyword(s):  
Multiple Pregnancy ◽  
Neurodevelopmental Outcome ◽  
Reproductive Technology ◽  
Reproductive Age ◽  
Case Presentation ◽  
Cross Border ◽  
Advanced Reproductive Age ◽  
Post Menopausal ◽  
Donor Eggs

Abstract Background We discuss the challenges of multiple pregnancy at very advanced reproductive age. Case Presentation We present the case of a quadruplet pregnancy at the maternal age of 65 following in-vitro fertilization (IVF) with donor eggs and sperm, involving cross-border reproductive care. All children born were at 25 weeks gestation and survived; however, poor neurodevelopmental outcome remains a major concern in one child. Conclusions The use of reproductive technology to achieve a multiple pregnancy at such an advanced post-menopausal age generated a debate on ethical, psychosocial and medical questions. We share this debate and highlight the need to reconsider international guidelines for women of advanced reproductive age.

scholarly journals Single fetal demise in multiple pregnancy

2019 ◽  
Vol 6 (5) ◽  
pp. 31-38 ◽  
Author(s):  
A. A. Kuznetsov ◽  
A. N. Romanovsky ◽  
A. V. Shlykova ◽  
T. A. Kashtanova ◽  
V. V. Shman ◽  
...  
Keyword(s):  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
Neurological Complications ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Perinatal Morbidity ◽  
Delivery Time ◽  
Monochorionic Twins ◽  
Fetal Demise ◽  
Management Of Complications

Single intrauterine fetal demise (sIUFD) in multiple pregnancy occurs with frequency from 3.7 up to 6.8 % and is associated with an risk of premature birth, death of cotwin and high morbidity and mortality rates in newborns. The time of sIUFD and type of twin gestation would determine perinatal outcomes. The rate of prenatal death of the co-twin is different and depend on the type of multiple pregnancy, accounting 4 % for dichorionic and 12 % in monochorionic pregnancies. However, the correlation between the type of chorionicity, delivery time and the frequency of preterm delivery is not clearly established. The risk of neurological complications in newborns after sIUFD fluctuate significantly in case of the type of chorionicity and could achieve 18 % in monochorionic twins and only 1 % in dichorionic twins. The paper was discussed the main reasons for sIUFD in multiple pregnancy, rather pathophysiological aspects of perinatal morbidity and mortality for cotwin was also discussed. The management of complications, methods of their correction, optimal methods and time of delivery in case of sIUDF in multiple pregnancies was presented.

Single center experience in selective feticide in high-order multiple pregnancy: clinical and ethical issues

2016 ◽  
Vol 44 (2) ◽  
Author(s):  
Giovanni Monni ◽  
Tamara Illescas ◽  
Ambra Iuculano ◽  
Marcella Floris ◽  
Federica Mulas ◽  
...  
Keyword(s):  
Pregnancy Loss ◽  
Ethical Issues ◽  
Chromosomal Abnormalities ◽  
Multiple Pregnancy ◽  
Nuchal Translucency ◽  
High Order ◽  
Single Center ◽  
Operator Experience ◽  
Single Center Experience ◽  
Time Period

AbstractThis paper describes the 20-year experience with selective feticide (SF) of high-order multiple quadruplet and higher pregnancies in a single center.The paper describes protocols, procedures, management, outcomes, and ethical issues.SF was performed in 49 pregnancies with 244 fetuses, with median gestational age of 12+2 weeks. The initial number was nine (one case), eight (one case), seven (three cases), six (11 cases), five (eight cases), and four (27 cases). Nuchal translucency was utilized prior to the procedure starting in 1996. The technique was transabdominal ultrasound-guided and intrathoracic injection of potassium chloride. One pregnancy (with seven fetuses) was reduced to three, 42 to two, and four (starting with four fetuses) to singletons. There were ten pregnancy losses (20.4%). A decreasing trend in losses was evident over the 20-year time period: 7/23 (30.4%) from 1994 to 2004 down to 3/26 (11.5%) for 2004–2014. No chromosomal abnormalities were present in any of the survivors. The ethical issues focus on the justification of SF in high-order multifetal pregnancies.In this series, pregnancy loss decreased with operator experience. Excellent outcomes can be achieved with the ethically justified use of feticide in high-order multiple pregnancies.

scholarly journals Study on HELLP syndrome - maternal and perinatal outcome

2017 ◽  
Vol 6 (2) ◽  
pp. 714 ◽  
Author(s):  
Lakshmi Narayana Kota ◽  
Kavitha Garikapati ◽  
Prabha Devi Kodey ◽  
Gayathri K. B.
Keyword(s):  
Hellp Syndrome ◽  
Liver Enzymes ◽  
Economic Status ◽  
Age Group ◽  
Perinatal Morbidity ◽  
Socio Economic Status ◽  
Clinical Presentations ◽  
Elevated Liver Enzymes ◽  
Low Platelet Count ◽  
Laboratory Investigations

Background: HELLP Syndrome is a serious obstetric complication in pregnancy characterised by haemolysis, elevated liver enzymes and low platelet count. Incidence is 0.5-0.9% of all pregnancies and in 10-20% of cases with severe preeclampsia and eclampsia. The aim of the study was to study the incidence, different clinical presentations and diagnosis of HELLP syndrome in Pre eclampsia and Eclampsia and to analyze the severity, complications, maternal and perinatal outcome.Methods: It is a 16 months period retrospective study of 102 cases of preeclampsia and eclampsia admitted in NRIMC and GH in OBGY Department with more than 28 weeks gestation. Of these, 91 cases had preeclampsia and 11 cases had eclampsia. Out of these, 15 cases developed HELLP Syndrome. The available history, clinical data, detailed laboratory investigations were studied and categorized by Mississippi classification for better analysis of complications and outcome in HELLP syndrome.Results: Of 91 cases of Preeclampsia, 12 cases (13.18%) developed HELLP syndrome and out of 11 cases of Eclampsia, 3 cases (27.27%) had HELLP Syndrome. Majority of the cases belonged to 21-25years age group and were mostly from lower Socio economic status. The present study showed 60% maternal morbidity and 6.6% maternal mortality and the perinatal morbidity and mortality was 46.6% each.Conclusions: HELLP Syndrome is a severe variant and a dreadful complication of Preeclampsia and Eclampsia, it needs early diagnosis and timely intervention in the form of termination of pregnancy to arrest further progress of pathophysiology leading to complications.

scholarly journals Perimyocarditis following first dose of the mRNA-1273 SARS-CoV-2 (Moderna) vaccine in a healthy young male: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ammar A. Hasnie ◽  
Usman A. Hasnie ◽  
Nirav Patel ◽  
Muhammad U. Aziz ◽  
Min Xie ◽  
...  
Keyword(s):  
Case Report ◽  
Myocardial Injury ◽  
Young Male ◽  
Pleuritic Chest Pain ◽  
Case Presentation ◽  
Time Period ◽  
Multiple Imaging ◽  
Wall Motion Abnormalities ◽  
Ongoing Monitoring ◽  
Hospital Center

Abstract Background Half of U.S. adults have received at least one dose of the COVID-19 vaccines produced by either Pfizer, Moderna, or Johnson and Johnson, which represents a major milestone in the ongoing pandemic. Given the emergency use authorizations for these vaccines, their side effects and safety were assessed over a compressed time period. Hence, ongoing monitoring for vaccine-related adverse events is imperative for a full understanding and delineation of their safety profile. Case presentation An 22-year-old Caucasian male presented to our hospital center complaining of pleuritic chest pain. Six months prior he had a mild case of COVID-19, but was otherwise healthy. He had received his first dose of the Moderna vaccine three days prior to developing symptoms. Laboratory analysis revealed a markedly elevated troponin and multiple imaging modalities during his hospitalization found evidence of wall motion abnormalities consistent with a diagnosis of perimyocarditis. He was started on aspirin and colchicine with marked improvement of his symptoms prior to discharge. Conclusions We present a case of perimyocarditis that was temporally related to COVID-19 mRNA vaccination in an young male with prior COVID-19 infection but otherwise healthy. Our case report highlights an albeit rare but important adverse event for clinicians to be aware of. It also suggests a possible mechanism for the development of myocardial injury in our patient.

scholarly journals Anesthesia Management in Caesarean Section with Preeclampsia and Partial HELLP Syndrome

2021 ◽  
Vol 1 (1) ◽  
pp. 8-14
Author(s):  
Tiara Wima ◽  
Agustina Br. Haloho
Keyword(s):  
Blood Pressure ◽  
Case Report ◽  
Cesarean Section ◽  
Hellp Syndrome ◽  
Surgical Stress ◽  
Fetal Mortality ◽  
Case Presentation ◽  
Mortality And Morbidity ◽  
Anesthesia Management ◽  
Emergency Cesarean

Introduction. Pre-eclampsia is a significant cause of maternal and fetal mortality and morbidity. Pre-eclampsia is characterized by hypertension (blood pressure ≥ 140/90 mmHg), oedema and amount of protein in urine 300 mg in the 24-hour, which appears after 20 weeks of gestation. Pre-eclampsia can cause complications, one of which is HELLP syndrome. This case report discusses the use of anaesthesia in a patient who underwent a cesarean section with indications for pre-eclampsia and partial HELLP syndrome. Case Presentation. A woman, 41 years old, G4P3A0 34 weeks pregnant with pre-eclampsia + syndrome HELLP will undergo emergency cesarean section with ASA IIE physical statusLabouror pain management was carried out using regional spinal anaesthesia technique, using bupivacaine 0.5% hyperbaric agent 12.5 mg. The operation lasted for 1 hour 30 minutes, with 300 ml bleeding, hemodynamically stable. Conclusion. Difficult intubation in emergency cases can be avoided by choosing of neuraxial anaesthesia technique is recommended. It will lead to better uteroplacental perfusion, good analgesia/anaesthesia quality, reducing surgical stress, reducing drugs that enter the uteroplacental circulation, and maternal psychological to be able to see the baby at birth.

Routine Cervical Cerclage in Higher Order Multiple Gestation — Does It Prolong the Pregnancy?

Twin Research ◽  
2002 ◽  
Vol 5 (2) ◽  
pp. 67-70 ◽  
Author(s):  
Alexander Strauss ◽  
Ivo M. Heer ◽  
Udo Janßen ◽  
Christian Dannecker ◽  
Peter Hillemanns ◽  
...  
Keyword(s):  
Gestational Age ◽  
Perinatal Outcome ◽  
Positive Impact ◽  
Multiple Pregnancy ◽  
Medical Intervention ◽  
Multiple Gestation ◽  
Perinatal Morbidity ◽  
Cervical Cerclage ◽  
Significant Difference ◽  
Prophylactic Cerclage

AbstractPreterm birth following cervical dilatation is the greatest threat to infants of a multiple pregnancy. Lacking reliable data concerning the effect of prophylactic cerclage, we compared a study group to controls for maternal and perinatal outcome. Sixteen of 94 triplet-, 9 of 18 quadruplet/quintuplet-pregnancies, treated with prophylactic cerclage, were retrospectively compared to those without cervical cerclage respectively. Kruskal-Wallis test and Mann-Whitney-U test were performed as non-parametric one way analysis of variance. For the analysis of frequencies Chi Square test or Fisher’s exact test were performed. Odds ratio with 95% confidence interval was used to compare the need for intravenous tocolysis as well as perinatal morbidity and mortality. Gestational age at delivery was not different from the controls in all studied groups. Birth weight revealed a 200g dominance for the “no cerclage-triplets”, while this significant difference was inverted for quadruplets/quintuplets (1245g vs. 1069g). With respect to gestational age at birth, need for hospitalisation or medical intervention no benefit was achieved. Moreover, perinatal outcome analysed by arterial pH, APGAR-Score and perinatal mortality was not altered by a prophylactic cerclage. Perinatal morbidity for quadruplets and quintuplets was even higher in cerclage pregnancies. Therefore, these retrospective results disclaim a positive impact of cervical cerclage on pregnancy management or perinatal outcome in multifetal pregnancies.

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