1/28. Intensive-care management of a patient with hellp syndrome--case report.hellp syndrome belongs to the group of pathological states known as pregnancy-induced hypertension or EPH gestosis. The basic criteria for establishing the diagnosis are as follows: H for hemolysis, EL for elevated liver enzymes and LP for low platelets. A pregnant woman, 38 years of age, multipara (V pregnancy, third delivery) has been admitted to the Clinic of gynecology and obstetrics in Novi Sad in 36-37 week gestation complaining of nausea, vomiting, epigastric pain, general weakness, exhaustion as well as symptom of previously diagnosed preeclampsia. Due to signs of fetal distress, the patient has undergone urgent cesarean section, giving birth to a female premature newborn infant. Twenty-four hours after delivery all symptoms and signs hellp syndrome manifested. Being in a critical state, the patient has been transferred to the Institute of Surgery, Clinic of anesthesiology and intensive care with signs of multiple organ failure. With this case report of a patient with hellp syndrome, we wished to point to importance of continual intensive clinical follow-up, laboratory monitoring and corresponding therapeutic procedures, and at the same time to this relatively rare syndrome.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
2/28. 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).- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
3/28. hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome with acute cortical blindness.The coincidence of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome and cortical blindness is an uncommon but very dramatic event. We describe a case of hellp syndrome complicating with acute cortical blindness before delivery. A 27 year-old woman, gravida 1, para 0, with normal medical history, was referred to our emergency department at the 33th week of gestation due to headache, vomiting, and blurred vision. The ophthalmologic examination showed intact pupillary light reflexes and normal ophthalmoscopic findings, but no light perception in either eye. brain computed tomography showed normal findings. hellp syndrome and preeclampsia was diagnosed based on the findings of hypertension and proteinuria as well as laboratory data. Prompt delivery was performed in order to achieve good maternal and neonatal outcomes.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
4/28. Recombinant factor viia (rFVIIa) is effective at massive bleeding after caesarean section--a case report.A case of 31-year old woman who underwent emergency caesarean section (CS) following suspicion of the hellp syndrome was reported. She developed arterial hypertension in 33rd week. In 38th week of her gestation elevated liver enzymes and positive albumin in urine were reported and pathological flow in umbilical artery and fetal aorta was found on ultrasound. The HELLP score was 12 and the hellp syndrome was diagnosed. The pregnancy was terminated by CS for fetal distress and the hellp syndrome. Two hours after the section she developed massive uterine bleeding with the signs of hemorrhagic shock. Despite of replacement therapy laboratory data worsened. DIC was diagnosed. Recombinant factor viia was administrated; after several minutes bleeding decreased and laboratory data normalized.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
5/28. ketanserin in women with chronic hypertension and underlying thrombophilia.BACKGROUND: pregnant women with chronic hypertension and thrombophilia have an increased risk for preeclampsia and/or intrauterine growth restriction (IUGR). ketanserin lowers blood pressure and inhibits serotonin-induced platelet aggregation. CASES: A 38-year-old woman with chronic hypertension had a first pregnancy with severe hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. A second pregnancy with prophylactic oral ketanserin and low-dose aspirin was uneventful. The third pregnancy without oral ketanserin was again complicated by severe superimposed preeclampsia and IUGR. During this pregnancy a prothrombin mutation was found. A 37-year-old woman with chronic hypertension developed severe early-onset superimposed preeclampsia in her first pregnancy. In the 3 consecutive pregnancies, she was treated with low-molecular-weight heparin because of a factor xii deficiency. Only the pregnancy with the use of prophylactic oral ketanserin was uncomplicated. CONCLUSION: Clinical trials are warranted to analyze the role of oral ketanserin in preventing preeclampsia and IUGR.- - - - - - - - - - ranking = 8.8208121078853keywords = blood pressure, hypertension, pressure (Clic here for more details about this article) |
6/28. Hepatic ischemia associated with coarctation of the aorta in pregnancy: key issues in differential diagnosis.BACKGROUND: Hepatic ischemia associated with coarctation of the aorta has not previously been reported in an adult; pregnancy increases the pressure gradient across a coarctation. CASE: A young woman with known coarctation of the aorta developed severe hepatic ischemia in pregnancy. A pregnancy-induced increase in the mean pressure gradient across the coarctation, from 18 mm Hg before pregnancy to 40 mm Hg in the third trimester, predisposed to critical hepatic hypoperfusion in the setting of dehydration. CONCLUSION: This case documents an association between coarctation of the aorta and hepatic ischemia, precipitated by pregnancy and dehydration in combination. It emphasizes the need in the assessment of patients with liver disease in pregnancy to consider not only "traditional" pregnancy-related conditions such as acute fatty liver and the hemolysis, elevated liver enzymes, low platelets syndrome, in which delivery may be necessary as a clinical emergency, but also those in which the circulatory and metabolic demands of pregnancy may precipitate liver injury.- - - - - - - - - - ranking = 0.075281998058389keywords = pressure (Clic here for more details about this article) |
7/28. Diagnostic dilemma: hepatic rupture due to hellp syndrome vs. trauma.CASE REPORT: We herein present the first reported case of a pregnant patient with underlying pregnancy-induced hypertension and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome who presented with hepatic rupture following a minor motor vehicle accident. DISCUSSION: The diagnostic dilemma between spontaneous hellp syndrome-associated versus trauma-related hepatic rupture is discussed.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
8/28. Systemic lupus erythematosus complicated by hellp syndrome.We describe a pregnant woman with systemic lupus erythematosus, complicated by severe pre-eclampsia (the hellp syndrome) and adult respiratory distress syndrome, who died in the intensive care unit. A 33-year-old multigravid woman was referred to our university hospital at 17 weeks' gestation because of an exacerbation of systemic lupus erythematosus with elevated liver enzymes and thrombocytopenia. At the time of admission, on physical examination she had revealed a butterfly rash over the cheeks, purpura, acute synovitis and oedema of the legs. Her blood pressure was 180/100 mmHg. The initial laboratory tests and immunological evaluation confirmed active systemic lupus erythematosus complicated by severe pre-eclampsia. One week after admission, she became suddenly confused and had a convulsion with Glascow coma Score 10 (3 3 4). Therapeutic abortion was induced in the Obstetric Department. She was transferred to the intensive care unit with a diagnosis of respiratory failure, probably due to acute respiratory distress syndrome, and was intubated and ventilated. dialysis was instituted on two consecutive days from the eighth day. In total she received over 20 units of red blood cells and large quantities of fresh frozen plasma and platelets. On the 24th day her Glascow coma Score was 2 (1 1 E) and severe hypotension developed. She died from worsening acute respiratory distress syndrome on the 25th day. Women with systemic lupus erythematosus should be advised to become pregnant when the disease is inactive and should be observed at an appropriate centre using a multidisciplinary approach. Therapeutic abortion is an acceptable option if active nephropathy and severe pre-eclampsia are present in early pregnancy.- - - - - - - - - - ranking = 1.8208121078853keywords = blood pressure, pressure (Clic here for more details about this article) |
9/28. General anesthesia with remifentanil for cesarean section in a patient with hellp syndrome.hellp syndrome is a severe complication of pre-eclampsia characterised by hemolysis, elevated liver enzymes and a low platelet count. It is associated with an increased risk of adverse outcome for both the mother and the fetus. patients with hellp syndrome are also at greater risk of pulmonary edema, adult respiratory distress syndrome, abruptio placentae, intracerebral hemorrhage, eclamptic convulsions, disseminated intravascular coagulation, ruptured liver hematomas and acute renal failure. perinatal mortality is equally high. Before delivery, aggressive obstetric management is directed toward stabilization of the affected organ systems, if possible, and interruption of the pregnancy in the early phase of the accelerated disease progression. Definitive therapy is delivery. Parturients hellp syndrome often require general anesthesia for cesarean section delivery. The anesthetic technique is critical for these patients with a high risk of uncontrollable hypertension, bleeding and multiple organ failure. Remifentanil is increasingly used as a very short analgesic agent providing cardiovascular stability in high-risk patients. We report the management of a patient presenting in labor with hellp syndrome, and describe the successful use of remifentanil as part of the anesthetic technique for her subsequent cesarean section.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
10/28. Congenital solitary kidney with renovascular hypertension diagnosed by means of captopril-enhanced renography and magnetic resonance angiography.A 24 year-old woman had a congenital solitary kidney with renovascular hypertension due to fibromuscular dysplasia. She had been treated as having essential hypertension until she developed preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome at 28 weeks of gestation. plasma renin activity and captopril test results did not indicate any abnormalities. However, renography revealed captopril-induced deterioration. magnetic resonance angiography was also useful to detect renal artery stenosis. These findings were confirmed by renal angiography. After successful percutaneous transluminal renal angioplasty, her blood pressure and the pattern of captopril renography normalized.- - - - - - - - - - ranking = 7.8208121078853keywords = blood pressure, hypertension, pressure (Clic here for more details about this article) |
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