11/152. Highly abnormal maternal inhibin and beta-human chorionic gonadotropin levels along with severe HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome at 17 weeks' gestation with triploidy. A 17-week pregnancy complicated by severe hypertension is reported. The fetus had multiple anomalies and was found to have triploidy. Assay of maternal serum markers for trisomy 21 revealed elevated levels of inhibin (137.51 multiples of the median) and human chorionic gonadotropin (41.51 multiples of the median). ( info) |
12/152. Spontaneous hepatic rupture in pregnancy. The HELLP-syndrome (haemolysis, elevated liver enzymes, low platelets) is associated with pre-eclampsia and may cause subcapsular liver haematomas. When hepatic rupture occurs the mortality of mother and unborn is high. rupture remains a surgical emergency with control of bleeding based on trauma principles. We report a case and discuss the diagnosis and management. ( info) |
13/152. hellp syndrome with haemaglobin vasospasm. The syndrome of haemolysis, elevated liver enzymes and low platelets (hellp syndrome) is a life threatening, severe complication of pre-eclampsia with typical laboratory findings. An unusual case of a 36-year-old woman with hellp syndrome and the initial complication of intracerebral haemorrhage is presented. The diagnosis of hellp syndrome was confirmed by elevated liver enzymes, low platelets, increased total bilirubin and increased lactate dehydrogenase. The intracranial haematoma was removed with good neurological recovery ensuing. However, this case was complicated by cerebral vasospasm on the eleventh day, confirmed by cerebral angiography and computer tomographic findings. The patient died from brain swelling. Possible vasospam should be considered during the treatment of patients with hellp syndrome. ( info) |
| PURPOSE: To present a rare case of central retinal vein occlusion in conjunction with the hellp syndrome. methods: A 30-year-old woman presented in the 28th week of her second pregnancy with severe pre-eclampsia with hellp syndrome; delivery by caesarean section was recommended. Ten days later, the patient complained of severely decreased visual acuity in her right eye. RESULTS: ophthalmoscopy revealed a central retinal vein occlusion with venous engorgement and tortuosity, multiple flame hemorrhages, and disc and macular edema. electroretinography revealed a reduction of b-wave/a-wave ratio. fluorescein-angiography showed a blockage due to extensive retinal hemorrhages with late mild staining of the walls of veins. The patient presented a spontaneous improvement in visual acuity (0.8 two months after) and a complete resolution of ophthalmoscopic findings. CONCLUSION: Ophthalmic complications are possible during and soon after this syndrome. This is the first description of a patient suffering a central retinal vein occlusion during puerperium after the hellp syndrome. ( info) |
15/152. Unusual presentation of mesangial proliferative glomerulonephritis in hellp syndrome associated with acute renal failure. Acute renal failure in pregnancy is not common in industrialized countries. hellp syndrome (hemolysis, elevated liver enzyme, and low platelets) was one of the causes of acute renal failure in pregnancy, but renal pathological findings in case of acute renal failure had rarely been reported. We reported an unusual case of hellp syndrome with acute renal failure requiring renal replacement therapy and which histopathologic findings of kidney biopsy showed mesangial proliferative glomerulonephritis and her renal function completely recovered after immediate artificial abortion, supportive management, transfusion of blood products, and hemodialysis. ( info) |
| A case of hepatic complication in a pregnant woman suffering from hellp syndrome resulting in the need for transplantation is reported, and an algorithm for those instances is suggested. According to the literature, this is the 5th report of hepatic complications in hellp syndrome necessitating liver transplantation. Since all but one of the transplanted patients survived (as opposed to a high mortality in non-transplanted patients), it is concluded, that a timely decision for transplantation is a safe option in this high risk group. ( info) |
| We report the case of focal nodular hyperplasia-like nodular hepatic lesions, that developed in the liver of a 35-year-old Caucasian female who required orthotopic liver transplantation for budd-chiari syndrome. The rapid development of focal nodular hyperplasia-like lesions in a severe hepatic vascular disorder and in the absence of cirrhosis may represent an additional argument in favor of the vascular origin of focal nodular hyperplasia. The pathogenesis of the nodules is not clear, but pathological arterialization of the liver in hepatic vein thrombosis may be a candidate mechanism. ( info) |
18/152. Effect of corticosteroids on hellp syndrome: a case report. The hellp syndrome is associated with a high rate of prematurity, which is the major cause of neonatal morbidity and mortality. Several studies have demonstrated the feasibility of prolongation of pregnancies complicated by HELLP syndrome. Until now the role of an additive pharmacological regimen, and particularly the role of corticosteroids, is still not clear. We report a case of a successful prolongation of a pregnancy complicated by hellp syndrome and note a direct relationship with application and withdrawal of corticosteroids. A 26-year old primigravida was admitted with hellp syndrome in the 25th week of gestation. We commenced a therapy with 40 mg methylprednisolone i.v. once daily, with clinical symptoms and biochemical parameters improving within two days. On day 6 we discontinued steroid medication with a consecutive deterioration of all biochemical data and clinical symptoms. Corticosteroids were recommenced and within two hours an improvement of all symptoms and laboratory data was observed. overall we were able to prolong the pregnancy for 33 days. This case report underlines the beneficial effect of corticosteroids in patients with hellp syndrome. Thus steroids might be helpful for postponing deliveries in very preterm gestation and for stabilizing the maternal status. ( info) |
19/152. Characteristic magnetic resonance imaging for neurological assessment in hellp syndrome with eclampsia: a case report. hellp syndrome is a complication of pregnancy characterized by hemolytic anemia, elevated liver enzymes, and low platelets. We describe a patient who suffered a generalized tonic seizure as a clinical onset. magnetic resonance imaging (MRI) of the brain showed high intensity lesions on T2-weighted images and low- and iso- intensity on T1-weighed images. The patient fully recovered and on follow-up MRI the abnormal lesions were almost totally resolved. The sensitivity and specificity of MRI is useful in distinguishing this complication of pregnancy from cerebral apoplexy, brain tumor, epilepsy and other causes. ( info) |
20/152. Severe hellp syndrome remote from term. A 27 year-old nulliparous woman was admitted to University College Hospital Galway with severe preeclampsia at 21 weeks 'gestation. In addition, there was evidence of hellp syndrome with renal failure. A decision was made to end the pregnancy to save the mother's life. Labour was induced with misoprostol and vaginal delivery of a male stillborn fetus weighing 250 g was achieved after 19 hours. The condition of the patient improved gradually following delivery. Renal impairment, however, persisted postpartum. hellp syndrome is a life-threatening complication of pregnancy which can only be cured by delivery. Other therapeutic modalities are only palliative but may improve the outcome for the very premature viable fetus. Conservative management is not an option when hellp syndrome occurs long before fetal viability has been reached. ( info) |