scholarly journals Transcatheter Arterial Embolization for Spontaneous Hepatic Rupture Associated with HELLP Syndrome: A Case Report

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1055
Author(s):  
In-Chul Nam ◽  
Jung-Ho Won ◽  
Sungbin Kim ◽  
Kyungsoo Bae ◽  
Kyung-Nyeo Jeon ◽  
...  
Keyword(s):  
Transcatheter Arterial Embolization ◽  
Hellp Syndrome ◽  
Liver Enzymes ◽  
Arterial Embolization ◽  
Fetal Mortality ◽  
Attractive Alternative ◽  
Hepatic Rupture ◽  
Emergency Cesarean ◽  
Elevated Liver Enzymes ◽  
Threatening Condition

Background: Spontaneous hepatic rupture associated with the syndrome characterized by hemolysis, elevated liver enzymes, and a low platelet count (HELLP syndrome) is a rare and life-threatening condition, and only a few cases regarding the management of this condition through transcatheter arterial embolization (TAE) have been previously reported. Case summary: Herein, we report a case involving a 35-year-old pregnant woman who presented at 28 weeks of gestation with right upper quadrant pain, hypotension, and elevated levels of liver enzymes. Transabdominal ultrasound revealed fetal death. She required an emergency cesarean section, and hepatic rupture was identified after the fetus had been delivered. Hepatic packing and TAE were performed. The postprocedural course was uneventful, and the patient was discharged 14 days after she had been admitted to our hospital. Conclusions: Spontaneous hepatic rupture associated with HELLP syndrome is a very serious condition that requires prompt and decisive management. The high maternal and fetal mortality rates associated with this condition can be reduced through early accurate diagnosis and adequate management. The findings in the reported case indicate that TAE may be an attractive alternative to surgery for the management of spontaneous hepatic rupture associated with HELLP syndrome.

HELLP syndrome and HELLP-like syndrome in pregnancies with covid-19 – case reports

2021 ◽  
Vol 86 (4) ◽  
pp. 236-241
Author(s):  
Jana Čivrná ◽  
◽  
Daniela Skanderová ◽  
Jiří Ehrmann ◽  
Radovan Pilka
Keyword(s):  
Case Report ◽  
Lactate Dehydrogenase ◽  
Hellp Syndrome ◽  
Liver Enzymes ◽  
Case Reports ◽  
Delayed Diagnosis ◽  
Hepatic Rupture ◽  
Elevated Liver Enzymes ◽  
Laboratory Results ◽  
Unnecessary Intervention

Summary: Objective: We present two case reports of severe course of covid-19 in pregnancy demonstrating similarity between covid-19 and HELLP syndrome. Case report: The fi rst case report describes an asymptomatic course of covid-19 accompanied by elevation of liver enzymes and lactate dehydrogenase but low ratio of angiogenic bio markers. No severe pregnancy complication occurred. All laboratory results had normalized after recovering from covid-19. The second case report describes a patient with elevated liver enzymes and lactate dehydrogenase which preceded a respiratory failure. Furthermore, one of the most feared complication of pregnancy occurred, namely hepatic rupture. After a delivery, the condition of the patient had been improving only slowly. It is not clear whether this condition represented a severe course of covid-19 or a concurrence of covid-19 and HELLP syndrome. Conclusion: A severe course of covid-19 in pregnancy may cause a diagnostic dilemma for its similarity between covid-19 and a specific complication of pregnancy – HELLP syndrome. This might lead to an unnecessary intervention and iatrogenic prematurity or underestimation of symptoms and delayed diagnosis of HELLP syndrome.

scholarly journals Fetomaternal outcome in women with hemolysis, elevated liver enzymes and low platelet count syndrome: a retrospective study

2020 ◽  
Vol 9 (9) ◽  
pp. 3798
Author(s):  
M. B. Divya ◽  
Nishi Roshini Kondakasseril ◽  
Mekkattukunnel Andrews Andrews
Keyword(s):  
Platelet Count ◽  
Retrospective Study ◽  
Hellp Syndrome ◽  
Liver Enzymes ◽  
Fetal Mortality ◽  
Variant Form ◽  
Maternal Complications ◽  
Mortality And Morbidity ◽  
Elevated Liver Enzymes ◽  
Low Platelet Count

Background: HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome which is a variant form of severe preeclampsia is an important cause of maternal and fetal mortality and morbidity. The importance lies in the early diagnosis and timely intervention for better fetal and maternal outcome. The objective of this study was to assess the maternal and fetal outcome in pregnancies complicated with HELLP syndrome.Methods: This is a retrospective study analyzing fetomaternal outcome in 63 women diagnosed with HELLP syndrome in the department of obstetrics and gynecology, Government Medical College, Thrissur from 1st January 2014 to 31st December 2016. Details were collected from data records library.Results: Among 7,566 deliveries, 63 women (0.83%) had HELLP syndrome. Mean age was 29.5 years. 47.6% (n=30) women developed HELLP syndrome at gestational age less than 34 weeks. Maternal complications were abruption (27.78%), acute kidney injury (16.67%), DIC (16.67%), sepsis (11.11%) and postpartum hemorrhage (11.11%). In this study, HELLP syndrome lead to one maternal death (1.58%). The perinatal mortality was 25.75%.Conclusions: HELLP syndrome is an alarming complication, which brings high maternal and perinatal morbidity and mortality.

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 Hemolysis, Elevated Liver Enzymes and Low Platelet (HELLP) Syndrome Associated with Systemic Lupus Erythematosus

2003 ◽  
Vol 42 (10) ◽  
pp. 1052-1053 ◽  
Author(s):  
Masayuki MATSUDA ◽  
Shigeaki MITSUHASHI ◽  
Megumi WATARAI ◽  
Kanji YAMAMOTO ◽  
Takao HASHIMOTO ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Hellp Syndrome ◽  
Liver Enzymes ◽  
Systemic Lupus ◽  
Elevated Liver Enzymes

scholarly journals The psychological experience of women who survived HELLP syndrome in Cape Town, South Africa

2014 ◽  
Vol 19 (1) ◽  
Author(s):  
Rizwana Roomaney ◽  
Michelle G. Andipatin ◽  
Anika Naidoo
Keyword(s):  
Hellp Syndrome ◽  
Liver Enzymes ◽  
Blood Platelets ◽  
African Women ◽  
Theory Approach ◽  
Psychological Experience ◽  
Lack Of Information ◽  
Risk Pregnancy ◽  
Elevated Liver Enzymes ◽  
South African Women

Background: Haemolysis, elevated liver enzymes and low platelet count (HELLP syndrome) is a high-risk pregnancy condition that could be fatal to mother and/or baby. It is characterised, as the acronym indicates, by haemolysis, elevated liver enzymes and low blood platelets. Objective: This study explored women in Cape Town’s psychological experience of HELLP syndrome.Method: Six participants who previously experienced HELLP syndrome were interviewed. Using a grounded theory approach, themes emerged and a model illlustrating the psychological experience of HELLP syndrome was constructed.Results: The major themes that emerged were the perceived lack of information, a need to assign blame and a shift in focus. Themes of not knowing and trance and/or surreal experience underpin the cognitive aspects of the HELLP syndrome experience. Themes that expressed feelings of an inability to control, whirlwind and/or rapid pace and support acted together to bind the experience. Finally, emotions such as anger, ambivalence, disbelief, anxiety, guilt, loneliness and fear were present throughout the experience.Conclusion: This study developed an initial exploratory model representing the psychological experience of HELLP syndrome in a sample of South African women. Underlying this entire experience was a perceived lack of information which had a profound effect on numerous aspects of the experience ranging from where to locate blame to the varied emotions experienced. Agtergrond: Die HELLP sindroom is ‘n hoë-risiko swangerskap toestand wat kan dodelik vir moeder en/of baba wees. Dit word gekenmerk deur hemolise, verhoogde lewerensieme en lae bloedplaatjies.Doelwit: Hierdie studie het Suid-Afrikaanse vroue se sielkundige ervaring van die HELLP sindroom ondersoek.Metode: Ses deelnemers wat voorheen HELLP sindroom ervaar het is ondervra. Met die gebuik van gefundeerde teorie as ‘n teoretiese raamwerk en ontleding het temas na vore gekom en ‘n model wat die sielkundige ervaring van HELLP sindroom illustreer, is gebou.Resultate: Die vernaamste temas wat na vore gekom het was die oënskynlike gebrek aan inligting, ‘n behoefte om skuld toe te skryf en ‘n verskuiwing in fokus. Die tema van nie weet en beswyming en/of surrealistiese ervaring ondersteun die kognitiewe aspekte van die HELLP sindroom. Temas wat gevoelens van geen beheer, warrelwind en/of vinnige tempo en ondersteuning uitgesprek het, het saam opgetree om die ervaring te bind. Ten slotte, emosies soos woede, teenstrydigheid, ongeloof, angs, skuldgevoelens, eensaamheid en vrees was teenwoordig in die hele ervaring.Gevolgtrekking: Hierdie studie het van’n aanvanklike ondersoekende model van die sielkundige ervaring van HELLP sindroom tot ‘n steekproef van die Suid-Afrikaanse vroue ontwikkel. Onderliggend aan hierdie hele ervaring was ‘n oënskynlike gebrek aan inligting wat ‘n diepgaande uitwerking gehad het op talle aspekte van die ervaring wat gewissel het van waar om die blaam te plaas tot die uiteenlopende ervaarde emosies.

scholarly journals Transcatheter Arterial Embolization with N-butyl-2 Cyanoacrylate Glubrans 2 for the Treatment of Acute Renal Hemorrhage Under Coagulopathic Condition

2020 ◽  
Author(s):  
Maofeng Gong ◽  
Xu He ◽  
Boxiang Zhao ◽  
Jie Kong ◽  
Tao Wang ◽  
...  
Keyword(s):  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Arterial Embolization ◽  
Hemodynamic Instability ◽  
Attractive Alternative ◽  
Safe Alternative ◽  
Renal Hemorrhage ◽  
Active Hemorrhage ◽  
Significant Difference

Abstract Background:The efficacy and safety of transcatheter arterial embolization (TAE) using the N-butyl-2 cyanoacrylate (NBCA) Glubran2 in the treatment of acute renal hemorrhage (RH) under coagulopathic conditionsarestill no consensus.Methods: Between February 2014 and June 2019, 8 patients underwent TAE with the NBCA Glubran2 for acute RH under coagulopathic conditions. Coagulopathy was defined as abnormal values of prothrombin time and activated partial thromboplastin time and/or a reduced platelet count.Angiograms and medical records were retrospectively reviewed to determine technical/clinical success, complications and recurrent hemorrhage after TAE, and follow-up outcomes were assessed.Results: Of note, one patient presented with severe coagulopathy, and three presented with severe RH and hemodynamic instability. The NBCA Glubran2 was employed as a sole embolic material in sixpatients. In the remaining two patients, it was employed for secondary embolization.Under coagulopathic conditions, due to the use of the NBCA Glubran2, both technical success and clinical success for acute RH were achieved in all patients. Duringa mean follow-up time of 30.1 months (range, 3-84 months), neither persistent nor recurrent active hemorrhage required repeat endovascular or surgical treatment for hemostasis. No Glubran2related complications occurred mid-TAE pro-cedure. In addition, renal function information was available for all patients, and there was no significant difference between the serum creatinine levels [(83.8 ± 15.5) vs (85.8 ± 32.2) μmol/L] before and one week after Glubran2 embolization (p=0.89; CI, -34.5 to 30.5).Conclusions: The present findings suggest that TAE with the NBCA Glubran2 may be a safe alternative treatment for the management of RH under coagulopathic conditions. In particular, this method appears to be a potentially attractive alternative when con-ventional embolic materials fail in patients with ongoing hemodynamic instability or even under severe coagulopathic conditions.

Sign in / Sign up

Export Citation Format

Share Document