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Query: UMLS:C0012739 (disseminated intravascular coagulation)
 8,673 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hypertension in pregnancy remains a major cause of maternal and fetal morbidity and mortality. It is a late manifestation of a multifactorial, multisystem disease, initiated very early in pregnancy, the features of which suggest an inadequate maternal response to pregnancy. There is a genetic susceptibility to pre-eclampsia. Endothelial cell dysfunction in response to an unknown factor(s) may evoke some of the hormonal anomalies. In established severe disease there is volume contraction, reduced cardiac output, enhanced vascular reactivity, platelet exhaustion and disseminated intravascular coagulation in addition to the hypertension. Delivery is associated with resolution of the hypertension. Pharmacological treatment is most suitable for early-onset, severe disease when an attempt to delay delivery is indicated. Methyldopa or beta-blockers and/or vasodilators may be used. ACE inhibitors are contra-indicated. Low-dose aspirin may be useful in prophylaxis.
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PMID:Pre-eclampsia--the 'disease of theories'. 791 88

The implications of thrombocytopenia in pregnancy vary with the etiology of the thrombocytopenia. This article focuses on defining what those etiologies are and assessing risk and therapy for each. Most important, the need to diagnose the largest and most benign entity of incidental thrombocytopenia is emphasized so that patients can be reassured and not subjected to further intervention. The angiopathic entities of preeclampsia, HELLP syndrome (hemolytic anemia, elevated liver function tests, and low platelets), disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, and hemolytic-uremic syndrome may also cause severe thrombocytopenia. The controversy surrounding the particular therapeutic dilemma of immune thrombocytopenic purpura is explored, with evaluation of the actual danger to the mother, method of delivery, and treatment for the neonate. The serious nature of alloimmune thrombocytopenia is emphasized, and current modes of risk assessment and therapy are discussed.
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PMID:Thrombocytopenia in pregnancy. 794 23

Spontaneous rupture of the liver associated with pregnancy is a rare and grave complication, usually occurring in preeclampsia or eclampsia. Two cases of ruptured subcapsular hematoma of the right liver during pregnancy are reported. The first case was a 19-year-old woman who had suffered from epigastralgia and absent fetal heart beat in the 32nd week of gestation. The second case was a 31-year-old female who complained of nausea and right upper quadrant pain in the 35th week of pregnancy. Both had preeclampsia, and developed shock with disseminated intravascular coagulation soon after admission. Both received surgery and were found to have ruptured hematoma over the right liver. Finally, the first patient died of renal failure, but the second survived because preoperative diagnosis had been exact. Greater suspicion, then awareness of diagnosis can lead to better timing of surgery and an improved prognosis for mother and child.
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PMID:Spontaneous rupture of the liver associated with pregnancy: a report of two cases. 798 38

The HELLP syndrome is a severe and life-threatening complication of preeclampsia with typical laboratory findings. The frequency of the disease is 1 to 150-300 live births in perinatal centers. The median gestational age at presentation is 34 weeks, however, the disease may also develop during the early postpartum period. Right upper quadrant pain is the most striking clinical symptom; in up to 15% of cases neither hypertension nor proteinuria is present on admission. For the detection of hemolysis determination of haptoglobin levels is the most suitable method. Coagulation disorders are more pronounced in patients with the HELLP syndrome as compared to those with preeclampsia without the HELLP constellation, however the full-blown syndrome of disseminated intravascular coagulation (DIC) is not a leading symptom but the consequence of delayed diagnosis and/or therapy of the primary disease. The course of the HELLP syndrome is unpredictable. On the one hand, complete reversal of symptoms under conservative treatment have been reported in individual cases, on the other hand, rapid, therapy-resistant deterioration of the disease had been observed in the majority of patients accompanied by severe complications (e.g. liver rupture). As a consequence the mother and the newborn need intensive care, and these women should be delivered in an obstetric intensive care unit. The maternal mortality reported from the international literature is 3.3%, and the perinatal mortality 22.6%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[HELLP syndrome]. 802 4

Fifty patients with severe pre-eclampsia who presented before 32 weeks' gestation were managed conservatively (sedation, bed rest, antihypertensive therapy and intensive fetal and maternal monitoring) until intervention was indicated. Twelve patients presented before 26 weeks of pregnancy and there were no fetal survivors in this group; 23 presented between 26 and 29 weeks and 8(34,8%) of the babies in this group survived. The rate of perinatal loss in those presenting between 30 and 32 weeks was 26,6% (N = 4). Patients who had a history of a hypertensive disorder in their previous pregnancy(ies) had a higher perinatal mortality rate; 23 such mothers experienced 16 perinatal losses compared with 27 mothers who had no such history and who had only 8 perinatal losses. There was 1 maternal death, there were 2 cases of eclampsia, 3 of pulmonary oedema, 4 of abruptio placentae and 1 case of renal failure; 2 patients had disseminated intravascular coagulation. The local indigent and underprivileged black population have a more aggressive form of early onset of severe pre-eclampsia than that reported for other population groups. The high maternal complication rate of 30,8% and the low fetal survival rate before 26 weeks indicate that there is no place in our setting for expectant management of severe pre-eclampsia in patients presenting before 26 weeks. This applies particularly to those with a previous history of hypertension in pregnancy.
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PMID:Expectant management of early onset of severe pre-eclampsia in Durban. 821 21

We describe a patient with previous venous thrombosis while using oral contraceptives and recurrent pregnancy loss, who presented with massive hepatic infarction in the last trimester of the fourth gestation. Thrombocytopenia, the lupus anticoagulant (LA) and the anticardiolipin antibody (aCL) were detected and a diagnosis of a 'primary' antiphospholipid syndrome (APS) was made. The clinical and histological manifestations and the differential diagnosis, especially with DIC and pre-eclampsia, are discussed.
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PMID:Hepatic infarction in a pregnant patient with the 'primary' antiphospholipid syndrome. 826 78

Between 1982 and 1992, 18 cases of pregnancy-related acute renal failure (PR-ARF) were observed (9% of the total number of ARF). Mean age of the women was 32 years (22-40 years). Uterine hemorrhage and preeclampsia/eclampsia were the major causes of ARF, accounting for 61% of the cases. Patchy renal cortical necrosis was suspected in 2 cases whereas signs of disseminated intravascular coagulation (DIC) or microangiopathic hemolytic anemia were present in 6 (33%) and 9 (50%) cases, respectively. Ten women required hemodialysis; and 6 of them, additional plasma exchange sessions. Five patients (28%) died during the acute phase of the illness, mainly due to brain damage, hepatic failure, and sepsis. Among the survivors, a complete (61.5%) or partial recovery (23.1%) was usually seen, but irreversible renal failure was recorded in 2 cases with postpartum hemolytic uremic syndrome (HUS). Short-lasting oligoanuria (< 3 days) represents a good prognostic index. However, the presence of vascular injury (cortical necrosis, HUS) seems to carry a poor prognosis. In conclusion, PR-ARF is still a critical occurrence, associated with serious prognosis for both women and kidneys. So far, the most effective measures remain the careful prevention and the aggressive management of the obstetric complications.
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PMID:Acute renal failure in pregnancy. 829 Jul 7

A 27-year-old Caucasian female, with a past history of recurrent spontaneous abortions, was admitted with pre-eclampsia at 26 weeks' gestation during her sixth pregnancy. She was previously known to have antiphospholipid antibodies since her fifth abortion, but had no clinical or serological evidence of systemic lupus erythematosus. A small-for-dates infant was delivered by emergency Caesarean section at 27 weeks for poor placental blood flow and fetal distress. She was transferred to the renal unit on the sixth post partum day with pulmonary edema, hypertension, disseminated intravascular coagulation and acute renal failure. Renal biopsy showed lesions compatible with thrombotic microangiopathy with diffuse glomerular necrosis. She was plasma exchanged and remained dialysis dependent for 7 months. Antiphospholipid antibodies were present in high titres and were the presumed cause of her acute renal failure. The patient now has stable renal function with a creatinine clearance of 30 ml/min for over two years. The late recovery of renal function is unique in the above circumstances.
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PMID:Reversible renal failure due to the antiphospholipid antibody syndrome, pre-eclampsia and renal thrombotic microangiopathy. 857 29

We report a case of preeclampsia presenting initially as a moderate hypertension, and complicated over a ten-day period by eclampsia, retinal hemorrhage, cerebral and hepatic subcapsular hematomas, HELLP syndrome, disseminated intravascular coagulation and renal failure. Fatal outcome was related to cerebral death and rupture of the liver hematoma. The case analysis points out inaccurate initial management: probable misdiagnosis of epigastric pain related to subcapsular hematoma, ineffective antihypertensive therapy, aspiration of the gastric content after benzodiazepine treatment of eclampsia, transfer of the patient without stabilisation of her clinical status.
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PMID:[Severe preeclampsia. Analysis of a case with fatal outcome]. 869 Aug 69

The HELLP syndrome is a severe and life-threatening form of preeclampsia associated with typical laboratory findings. The major problems are the fluctuating course of the disease, the unpredictable occurrence of severe maternal complications and the high maternal and perinatal mortality. Time-limited reversal of the laboratory parameters has been observed in 20-40% of cases; however, the majority of patients shows a deterioration of the disease within 1-10 days. As no reliable clinical and laboratory indicators exist, as well as no precisely defined cut-off values in predicting the course and prognosis, the outcome of the HELLP syndrome is unpredictable. The high maternal morbidity and mortality are mainly due to the development of disseminated intravascular coagulation (DIC); the frequency of DIC has been shown to increase significantly with the time interval between diagnosis and delivery. The management of the HELLP syndrome has been controversial, with some authors recommending a conservative approach to induce fetal maturity in pregnancies below the 32nd (34th) week of gestation, whereas the majority recommend immediate delivery by Caesarean section in patients with an unfavourable cervix irrespective of the gestational age. It is generally agreed that early diagnosis by laboratory screening methods is mandatory and that patients with the HELLP syndrome should be transferred to a perinatal centre. A literature review since 1990 clearly demonstrates that aggressive management is associated with a significant reduction in maternal and perinatal mortality. We believe that conservative management is only justified in cases of fetal immaturity under the following conditions: no evidence of progression of the disease, no suspected or manifest DIC, fetal wellbeing and intensive monitoring of the patient in a specialised obstetric care unit cooperating closely with experienced neonatologists and anaesthesiologists.
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PMID:[Aggressive versus conservative management of HELLP syndrome--a status assessment]. 876 81


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