The HELLP syndrome: clinical issues and management. A Review

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 present review highlights occurrence, diagnosis, complications, surveillance, corticosteroid treatment, mode of delivery and risk of recurrence. Methods: Clinical reports and reviews published between 2000 and 2008 were screened using Pub Med and Cochrane databases. Results and conclusion: About 70% of the cases develop before delivery, the majority between the 27th and 37th gestational weeks; the remainder within 48 hours after delivery. The HELLP syndrome may be complete or incomplete. In the Tennessee Classification System diagnostic criteria for HELLP are haemolysis with increased LDH (> 600 U/L), AST (≥ 70 U/L), and platelets < 100·109/L. The Mississippi Triple-class HELLP System further classifies the disorder by the nadir platelet counts. The syndrome is a progressive condition and serious complications are frequent. Conservative treatment (≥ 48 hours) is controversial but may be considered in selected cases < 34 weeks' gestation. Delivery is indicated if the HELLP syndrome occurs after the 34th gestational week or the foetal and/or maternal conditions deteriorate. Vaginal delivery is preferable. If the cervix is unfavourable, it is reasonable to induce cervical ripening and then labour. In gestational ages between 24 and 34 weeks most authors prefer a single course of corticosteroid therapy for foetal lung maturation, either 2 doses of 12 mg betamethasone 24 hours apart or 6 mg or dexamethasone 12 hours apart before delivery. Standard corticosteroid treatment is, however, of uncertain clinical value in the maternal HELLP syndrome. High-dose treatment and repeated doses should be avoided for fear of long-term adverse effects on the foetal brain. Before 34 weeks' gestation, delivery should be performed if the maternal condition worsens or signs of intrauterine foetal distress occur. Blood pressure should be kept below 155/105 mmHg. Close surveillance of the mother should be continued for at least 48 hours after delivery

Current best practice in the management of hypertensive disorders in pregnancy.

Preeclampsia is a potentially serious complication of pregnancy with increasing significance worldwide. Preeclampsia is the cause of 9%-26% of global maternal mortality and a significant proportion of preterm delivery, and maternal and neonatal morbidity. Incidence is increasing in keeping with the increase in obesity, maternal age, and women with medical comorbidities entering pregnancy. Recent developments in the understanding of the pathophysiology of preeclampsia have opened new avenues for prevention, screening, and management of this condition. In addition it is known that preeclampsia is a risk factor for cardiovascular disease in both the mother and the child and presents an opportunity for early preventative measures. New tools for early detection, prevention, and management of preeclampsia have the potential to revolutionize practice in the coming years. This review presents the current best practice in diagnosis and management of preeclampsia and the hypertensive disorders of pregnancy

The HELLP syndrome: Clinical issues and management. A Review

<p>Abstract</p> <p>Background</p> <p>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 present review highlights occurrence, diagnosis, complications, surveillance, corticosteroid treatment, mode of delivery and risk of recurrence.</p> <p>Methods</p> <p>Clinical reports and reviews published between 2000 and 2008 were screened using Pub Med and Cochrane databases.</p> <p>Results and conclusion</p> <p>About 70% of the cases develop before delivery, the majority between the 27th and 37th gestational weeks; the remainder within 48 hours after delivery. The HELLP syndrome may be complete or incomplete. In the Tennessee Classification System diagnostic criteria for HELLP are haemolysis with increased LDH (> 600 U/L), AST (≥ 70 U/L), and platelets < 100·10⁹/L. The Mississippi Triple-class HELLP System further classifies the disorder by the nadir platelet counts. The syndrome is a progressive condition and serious complications are frequent. Conservative treatment (≥ 48 hours) is controversial but may be considered in selected cases < 34 weeks' gestation. Delivery is indicated if the HELLP syndrome occurs after the 34th gestational week or the foetal and/or maternal conditions deteriorate. Vaginal delivery is preferable. If the cervix is unfavourable, it is reasonable to induce cervical ripening and then labour. In gestational ages between 24 and 34 weeks most authors prefer a single course of corticosteroid therapy for foetal lung maturation, either 2 doses of 12 mg betamethasone 24 hours apart or 6 mg or dexamethasone 12 hours apart before delivery. Standard corticosteroid treatment is, however, of uncertain clinical value in the maternal HELLP syndrome. High-dose treatment and repeated doses should be avoided for fear of long-term adverse effects on the foetal brain. Before 34 weeks' gestation, delivery should be performed if the maternal condition worsens or signs of intrauterine foetal distress occur. Blood pressure should be kept below 155/105 mmHg. Close surveillance of the mother should be continued for at least 48 hours after delivery.</p

Pregnancy-related liver disorders

Registo Grau Estrangeiro Medicina (Medical Faculty, Pavol Jozef Šafárik University in Košice, Slovakia.). A dissertação em questão cumpre o disposto no nº2 do artº 11º da Portaria nº 29/2008 de 10 de janeiro (alterada pela Portaria nº 227/2017 de 20 de julho

A Practical Understanding of Preeclampsia for a Nurse in a Third World Setting

Preeclampsia is a disease of pregnancy that affects approximately 3-5% of women with child. It is one of the primary causes of mortality in mothers and babies across the globe. The exact cause, pathogenesis, or disease progression is unknown. Therefore, there is no definition of which patients are at risk for developing preeclampsia and what can work as a preventative measure. In high socioeconomic settings where there is good healthcare, standard treatment is established to manage the symptoms and decrease the progression of preeclampsia to eclampsia. However, in more rural, third-world settings of developing countries, caring for patients with preeclampsia is not a straightforward matter. Due to decreased access to health care, low economic status, and lack of education, preeclampsia is often seen yet seldom treated among this population. The discussion below addresses several possible pathophysiological processes of preeclampsia, as well as potential risk factors. The standard treatments of care are then discussed, followed by the evaluation of studies regarding alternative treatments for preeclampsia. The importance of screening pregnant women in developing nations is included. The discussion is concluded by a summary of what caring for preeclampsia in a third-world setting might look like for a missionary nurse

Early onset preeclampsia is characterized by altered placental lipid metabolism and a premature increase in circulating FABP4

Preeclampsia is a pregnancy-associated disorder that manifests as a sudden increase in maternal blood pressure accompanied by proteinuria. Because the placenta is a key organ in preeclampsia, we used proteomic and lipidomic analyses to compare placentae from preeclamptic and gestational age matched control pregnancies. Fatty acid binding protein 4 (FABP4), enoyl-CoA dehydrogenase and delta-3,5-delta-2,4-dienoyl-CoA isomerase had altered abundance in preeclamptic placentae compared to controls. FABP4 placental protein and RNA and plasma levels were all increased in early-onset preeclampsia (prior to 28 weeks gestation) compared to controls (6-fold, 3.3-fold and 3.5-fold respectively). After 28 weeks, FABP4 protein in control placenta and plasma increased to the same concentrations as in preeclampsia. Total tetracosapentaenoic acid in preeclamptic placentae was decreased to 0.6 of control levels before 28 weeks. The data indicate a disruption of fatty acid transport and metabolism in the placenta in early onset preeclampsia that is reflected in the maternal plasma

Редкие виды спонтанных разрывов печени на фоне беременности

This literature review is devoted to the problem of spontaneous liver ruptures in pregnant women. Its goal was to raise awareness among physicians as one of the methods to improve the early diagnosis of the disease, as well as to consider the role of the hepatological surgeon in the surgical treatment of rare obstetric diseases. The main links of the pathogenesis of liver ruptures were considered, the problem of high maternal and perinatal mortality was disclosed. Based on the literature data, the most optimal obstetric and surgical treatment and diagnostic tactics for managing pregnant women with spontaneous liver ruptures were determined.Настоящий литературный обзор посвящен проблеме спонтанных разрывов печени у беременных. Его целью стало повышение информированности врачей как одного из методов улучшения ранней диагностики болезни, а также рассмотрения роли хирурга-гепатолога в рамках хирургического лечения редкого акушерского осложнения. Были рассмотрены основные звенья патогенеза разрывов печени, раскрыта проблема высокой материнской и перинатальной смертности. На основании данных литературы была определена наиболее оптимальная акушерская и хирургическая лечебно-диагностическая тактика ведения беременных со спонтанными разрывами печени

No Hypertensive Disorder of Pregnancy; No Preeclampsia-eclampsia; No Gestational Hypertension; No Hellp Syndrome. Vascular Disorder of Pregnancy Speaks for All

Hypertensive disorders complicate 5%-10% of pregnancies with increasing incidence mainly due to upward trends in obesity globally. In the last century, several terminologies have been introduced to describe the spectrum of this disease. The current and widely used classification of hypertensive pregnancy disorders was introduced in 1972 and in 1982, but has not been free of controversy and confusion. Unlike other diseases, the existing terminology combines signs and symptoms, but does not describe the underlying pathology of the disease itself. In this commentary, a detailed account is given to vascular disorder of pregnancy (VDP) as an inclusive terminology taking into account the underlying pathology of the disease on affected organs and systems. A simple and uniform classification scheme for VDP is proposed.Keywords: Gestational hypertension, HELLP syndrome, Hypertensive disorder of pregnancy, Preeclampsia-eclampsia, Vascular disorder of pregnanc