Liver Bleeding Due to HELLP Syndrome Treated With Embolization and Liver Transplantation: A Case Report and Review of the Literature

Background: Liver bleeding secondary to haemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is uncommon, but a life-threatening peripartum condition that needs a prompt multidisciplinary approach.Case Presentation: In this study, we presented a case of 28-year-old pregnant woman, who was presented to the obstetrics department with signs of preeclampsia and foetal growth restriction. An emergency caesarean section was performed, and the patient developed a HELLP syndrome complicated by spontaneous liver rupture. After radiological and surgical procedures, liver failure became evident and liver transplantation was successfully performed. The patient and her daughter are now alive.Conclusions: Despite the rarity of this disease, liver complications due to HELLP syndrome must be properly diagnosed and treated given the gravity of the possible evolution in young women. After diagnosis, the patients must be treated in specialised centres with gynaecological, liver surgery, and transplant skills.

Combination of human endothelial colony-forming cells and mesenchymal stromal cells exert neuroprotective effects in the growth-restricted newborn

The foetal brain is particularly vulnerable to the detrimental effects of foetal growth restriction (FGR) with subsequent abnormal neurodevelopment being common. There are no current treatments to protect the FGR newborn from lifelong neurological disorders. This study examines whether pure foetal mesenchymal stromal cells (MSC) and endothelial colony-forming cells (ECFC) from the human term placenta are neuroprotective through modulating neuroinflammation and supporting the brain vasculature. We determined that one dose of combined MSC-ECFCs (cECFC; 106 ECFC 106 MSC) on the first day of life to the newborn FGR piglet improved damaged vasculature, restored the neurovascular unit, reduced brain inflammation and improved adverse neuronal and white matter changes present in the FGR newborn piglet brain. These findings could not be reproduced using MSCs alone. These results demonstrate cECFC treatment exerts beneficial effects on multiple cellular components in the FGR brain and may act as a neuroprotectant.

Preeclampsia – long-term effects on mother and child

Preeclampsia (PE) is a pregnancy complication that affects 5% to 8% of all pregnancies. It is a leading cause of maternal mortality that contributes annually more than 60,000 maternal deaths all over the world. Data submitted so far by clinicians are still insufficient to completely understand the disease. Despite many researches, the prediction of patients suffering from PE remains difficult. Moreover therapeutic methods are also limited and concentrated on symptomatic treatment and early termination of pregnancy. The aim of the presented article is to review current research on the PE and its long-term effects on mother and child. PE is defined as a hypertension developing after 20 weeks of gestation with at least one of the following symptoms: proteinuria, maternal organ dysfunction or foetal growth restriction. Because initially patients may be completely asymptomatic, the diagnosis is usually difficult. Untreated PE may lead to the death of both mother and neonate. In later life it predisposes woman and child to cardiovascular and metabolic diseases. Maternal consequences are related to increased risk of hypertension, stroke, thrombosis or chronic kidney disease, whilst offspring implications are directly correlated with hypertension, increased body mass index, hormonal changes and reductions in cognitive functions. In the future there is a need to develop more effective diagnostic methods of PE. Comprehensive understanding of the pathophysiology would allow to avoid many negative long-term effects and reduce its mortality rate.

Elevated Circulating and Placental SPINT2 Is Associated with Placental Dysfunction

Biomarkers for placental dysfunction are currently lacking. We recently identified SPINT1 as a novel biomarker; SPINT2 is a functionally related placental protease inhibitor. This study aimed to characterise SPINT2 expression in placental insufficiency. Circulating SPINT2 was assessed in three prospective cohorts, collected at the following: (1) term delivery (n = 227), (2) 36 weeks (n = 364), and (3) 24–34 weeks’ (n = 294) gestation. SPINT2 was also measured in the plasma and placentas of women with established placental disease at preterm (<34 weeks) delivery. Using first-trimester human trophoblast stem cells, SPINT2 expression was assessed in hypoxia/normoxia (1% vs. 8% O2), and following inflammatory cytokine treatment (TNFa, IL-6). Placental SPINT2 mRNA was measured in a rat model of late-gestational foetal growth restriction. At 36 weeks, circulating SPINT2 was elevated in patients who later developed preeclampsia (p = 0.028; median = 2233 pg/mL vs. controls, median = 1644 pg/mL), or delivered a small-for-gestational-age infant (p = 0.002; median = 2109 pg/mL vs. controls, median = 1614 pg/mL). SPINT2 was elevated in the placentas of patients who required delivery for preterm preeclampsia (p = 0.025). Though inflammatory cytokines had no effect, hypoxia increased SPINT2 in cytotrophoblast stem cells, and its expression was elevated in the placental labyrinth of growth-restricted rats. These findings suggest elevated SPINT2 is associated with placental insufficiency.

How Do Uterine Natural Killer and Innate Lymphoid Cells Contribute to Successful Pregnancy?

Innate lymphoid cells (ILCs) are the most abundant immune cells in the uterine mucosa both before and during pregnancy. Circumstantial evidence suggests they play important roles in regulating placental development but exactly how they contribute to the successful outcome of pregnancy is still unclear. Uterine ILCs (uILCs) include subsets of tissue-resident natural killer (NK) cells and ILCs, and until recently the phenotype and functions of uILCs were poorly defined. Determining the specific roles of each subset is intrinsically challenging because of the rapidly changing nature of the tissue both during the menstrual cycle and pregnancy. Single-cell RNA sequencing (scRNAseq) and high dimensional flow and mass cytometry approaches have recently been used to analyse uILC populations in the uterus in both humans and mice. This detailed characterisation has significantly changed our understanding of the heterogeneity within the uILC compartment. It will also enable key clinical questions to be addressed including whether specific uILC subsets are altered in infertility, miscarriage and pregnancy disorders such as foetal growth restriction and pre-eclampsia. Here, we summarise recent advances in our understanding of the phenotypic and functional diversity of uILCs in non-pregnant endometrium and first trimester decidua, and review how these cells may contribute to successful placental development.

Multifactorial diabetes insipidus during pregnancy: a challenging diagnosis

Diabetes insipidus (DI) is characterised by thirst and polydipsia with hypotonic polyuria. Several forms exist, namely, central or pituitary, nephrogenic and gestational and must be differentiated for adequate treatment. We describe the case of a 41-year-old woman chronically infected with HIV who had been recently medicated with a tenofovir-based antiretroviral treatment and who, at 22 weeks of pregnancy, presented with transient gestational DI. Obstetric ultrasound revealed oligohydramnios and foetal growth restriction that did not improve despite serum sodium correction. The severity of the case suggested the presence of an underlying disorder and elevated copeptin levels indicated that an underlying subclinical form of nephrogenic DI, possibly induced by HIV-related nephropathy or tenofovir use, was present and rendered clinically overt during pregnancy.

Community Based Study of Preterm Births, Small for Gestation and Low Birth Weight Babies in Rural Tribal Women with Extreme Poverty

Background: Globally one-sixth of new-borns are Low Birth Weight (LBW), single most important risk factor for Neonatal deaths (NNDs), Preterm births (PTB), Small for gestational age (SGA), Foetal Growth Restriction (FGR) are responsible for LBW and most of perinatal mortality. Objective: Present community-based study was carried out to know burden of PTB, SGA, LBW babies among rural, tribal women. Material and Methods: After ethics committee’s approval prospective study was conducted in 100 villages. Results: Over 2 years, 3713 women delivered, 2287 (61.6%) babies were LBW, 239 (6.4%) PT, 165 (69%) PT SGA, 916 (26.4%) of 3474 term babies were SGA. Overall 26.4% babies were <2 kg, 32.5% ≥2 to <2.5 kg, only 38.4% babies ≥2.5 kg. Of 55 mothers who had very very very (VVV) LBW (<1 kg) babies, 4 (7.3%) had hypertensive disorders of pregnancy (HDsP), 45 (81.8%) anaemic 3 (5.5%) had other disorders, 3 (5.5%) had no obvious disorder (P-value 0.7754). Of 129 women with VVLBW (≥1 to <1.5 kg) babies, 10 (7.8%) had HDsP,107 (83.9%) anaemia, 9 (7.0%) other disorders, 3 (2.3%) had no obvious disorder (P-value 0.4842). Of 895 women with VLBW (≥1.5 to <2 kg) babies, 84 (9.4%) mothers had HDsP,733 (81.9%) anaemia, 49 (5.5%) other disorders, 29 (3.2%) no obvious disorder (P-value<0.0001). Of 1208 women with babies of ≥2 to <2.5 kg babies, 112 (9.3%) had HDsP, 971(80.4%) had anaemia, 87 (7.2%) other disorders, 38 (3.1%) no obvious disorder (P-value 0.0205). There were 6.4% perinatal deaths 7.4% amongst 2287 <2.5kg, 4.8% of 1426 ≥2.5kg (P-value 0.0085). Conclusion: Preterm births were not high but many babies were LBW, only 38.4% NW, 69% PT and 26.4% term babies were SGA. Anaemia seemed to be a major contributor