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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The HELLP syndrome is almost always encountered in patients with gravid hypertension. It is defined as the association between intravascular haemolysis, raised liver transaminase levels and thrombopenia. We report 2 cases of HELLP syndrome observed in the Gynecology-Obstetrics B ward in the Brazzaville (Congo) University Hospital in 1992. Frequency in the ward was estimated at 2.9% (2 cases among 67 patients hospitalized for pre-eclampsia). The two cases occurred at 29 weeks gestation in young, black, primipartants in a context of severe pre-eclampsia. The clinical course was rapidly favorable for the mother after delivery. One in utero fetal death occurred. Due to the number of maternal deaths recorded in the literature, we suggest that, in Africa, pregnancies should be interrupted in case of HELLP syndrome whatever the gestational age since proper medical facilities are need to care for these severe cases.
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PMID:[HELLP syndrome. Two cases observed at the University Hospital Center of Brazzaville (Congo)]. 765 Mar 21

Infrequently, severe preeclampsia-eclampsia with or without HELLP syndrome persists more than 24 to 48 hours into the postpartum period. Maternal morbidity and mortality is increased in these women who persist in their disease and do not rapidly resolve their hypertension, decreased urinary output, depressed platelet count, and other related abnormalities within 72 to 96 hours postpartum. When these worsen to include multiple system organ failure, infection, and fibrin consumption coagulation disorders, emergent and aggressive intervention is needed. Prophylactic treatment options to accelerate postpartum recovery include ultrasound-directed postpartum curettage and oral nifedipine therapy. In pregnancies complicated by HELLP syndrome, postpartum corticosteroids can be used to hasten the recovery from this disease. Delayed ultrasound-directed curettage and exchange plasmapheresis with fresh-frozen plasma can be used in pregnancies when evidence of recovery is absent or further deterioration is evident by 96 hours postpartum. Other specific system involvement, such as central nervous system or renal system, requires directed therapy unique to the individual condition and patient that is undertaken in association with consultants.
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PMID:Complicated postpartum preeclampsia-eclampsia. 765 75

The maternal mortality rate associated with eclampsia ranges from 100 to 6000 per 100,000, and the perinatal mortality rate ranges from 150 to 400 per 1000. Both eclampsia and its preceding condition, pregnancy-induced hypertension, occur in varying degrees in different parts of India. The warning signs of imminent eclampsia are 1) systolic blood pressure of 160 mmHg or more on two occasions six hours apart when the patient is on bed rest; 2) proteinuria of 5 g or more in 24 hours or 3 + or more by semiquantitative assay; 3) oliguria or anuria; 4) cerebral or visual disturbances; 5) pulmonary edema or cyanosis; and 6) epigastric/right hypochondriac pain, impaired liver function, and thrombocytopenia and coagulation disorders. Eclampsia is classified as the acute fulminating type, which can occur without warning, and the insidious type. Most cases (61%) show onset of eclampsia during the prenatal period. Treatment of eclampsia involves 1) control of convulsions (through an injection of magnesium sulphate or diazepam or the intravenous administration of phenytoin); 2) correction of hypoxia and acidosis; 3) a gradual lowering of blood pressure with hydralazine hydrochloride, nifedipine, atenolol, labetalol, oxprenolol, or metoprolol); and 4) steps to effect delivery. Diagnosis of HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) requires a complete blood count, blood film for platelet count and red blood cell fragmentation, and a coagulation screen for diagnosis of disseminated intravascular coagulation. Efforts to induce delivery in cases of prenatal eclampsia can take place 12-24 hours after convulsions have stopped. There is no reason to prolong pregnancy in the interests of the fetus, and in some cases Cesarean section may be required. Adequate prenatal care should allow the identification of almost every potential case of eclampsia and allow the prompt treatment of pre-eclampsia or termination of pregnancy when necessary. Medical staff must receive proper training to diagnose pre-eclampsia and treat the condition.
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PMID:Eclampsia. 765 39

Hypertension-induced hepatic disease is a common cause of abdominal pain and liver function test abnormalities in the pregnant patient. Liver hemorrhage and rupture, in turn, are the most unusual and serious complications of preeclamptic/eclamptic or HELLP (Hemolysis Elevated Liver enzymes and Low Platelet count) associated disease. Should a liver hematoma be documented, management must be aggressive, with treatment of hypertension, correction of any coagulopathy, and prompt delivery of the child. Rupture remains a surgical emergency with control of bleeding based on trauma principles. Postoperative care is difficult, with a propensity toward multiple system organ failure. With an aggressive multidisciplinary approach to the management of these patients, mortality rates have been decreased by fifty per cent. Subsequent pregnancies appear to carry no increased risk of liver rupture over the general population but should be followed carefully by a high-risk obstetrician.
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PMID:Hepatic hemorrhage and the HELLP syndrome: a surgeon's perspective. 766 69

Plasma levels of tumor markers (CEA, TPA, CA 15.3, CA 125, alpha-fetoprotein) for 50 patients with hypertensive disorders of pregnancy were compared with those of 50 healthy women with singleton pregnancies and 50 healthy non-pregnant controls. With the exception of CEA all tumor marker values were higher in pregnant women, these differences being statistically significant (all p < 0.0001). Alpha-fetoprotein was lower in hypertensive than in healthy pregnant women (p = 0.0004), whereas CEA, CA 15.3 and CA 125 showed no statistically significant differences. TPA values in patients with hypertensive disorders of pregnancy (median 190 U/l) were 2.7 times higher than those of healthy pregnant controls (median 70.5 U/l) with a statistically significant difference (p < 0.0001). The individual degrees of disease severity demonstrated increasing TPA medians (pregnancy-induced hypertension: 106.5 U/l; pre-eclampsia: 200 U/l; HELLP syndrome: 339 U/l). TPA levels correlated positively with clinical severity of disease and negatively with fetal (rs = -0.58; p < 0.0001) and placental weight (rs = 0.44; p = 0.01).
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PMID:Tumor markers in hypertensive disorders of pregnancy. 768 29

A 23-year-old female, gravida 0 para 0, underwent emergency cesarean section under general anesthesia, because of the complication of HELLP syndrome. Prostaglandin E1 (PGE1) was used to prevent hypertension and uterine atony just after the infant's delivery. The disorder was improved with the postpartum care. HELLP is the syndrome of hemolysis, elevated enzyme, and low platelets presented by a unique group of pre-eclamptic/eclamptic patients with or without the usual clinical findings of pregnancy-induced hypertension. PGE1 may be useful for microangiopathic hemolytic anemia, which might be related with the hemolysis, because of its inhibitory effect on both platelet aggregation and thrombus formation, and its ability to improve red cell deformability.
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PMID:[The use of prostaglandin E1 for emergency cesarean section in a patient with HELLP syndrome]. 769 14

Four cases of HELLP Syndrome (Haemolysis, Elevated liver enzymes, Low Platelet count) (HS) have given the authors an opportunity for this brief review. HS should be evoked in any pregnant woman with high blood pressure during the last term, for it is a real emergency. Symptomatic treatment and rapid extraction constitute the commonly accepted therapy, by which maternal and foetal morbidity and mortality can be considerably reduced.
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PMID:[HELLP syndrome and pregnancy hypertension: severity? Anesthetic management]. 772 6

A number of laboratory tests are available for the evaluation of the hypertensive gravida. These tests can be used to either predict and/or prognosticate between preeclampsia and other hypertensive disorders of pregnancy. These laboratory tests were evaluated based on published experience with special attention to its ability to facilitate identification of the patient with preeclampsia apart from other hypertensive disorders that co-exist with and occur as a complication of pregnancy. Hypocalciuria and increased cellular plasma fibronectin seem to be good tests to differentiate preeclampsia from chronic hypertension. The management of preeclampsia with its increased risk of perinatal morbidity and mortality renders this differentiation clinically very important. Hyperuricemia, proteinuria, increased serum beta-thromboglobulin concentration, abnormal red blood cell morphology with increased hemoglobin/hematocrit, and increased serum iron individually and collectively reflect the severity of preeclampsia. Platelets and total serum lactate dehydrogenase are the best tests to reflect the severity of HELLP syndrome. Circulating hCG and serum thromboglobulin seem to be the most promising future predictors for preeclampsia.
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PMID:The laboratory evaluation of hypertensive gravidas. 773 26

This is a review of 15 cases of severe pre-eclampsia with HELLP syndrome. The patients presented with severe arterial hypertension, the main symptoms were epigastric and right hypochondrial pain that were present in 66.6% of the patients, nausea and vomit in 53.8% and edema of the lower limbs in 60%. The most frequent age was in the third decade of life, and in the third trimester of pregnancy for all the cases, the main complication was acute renal insufficiency in 80% on the patients. Three patients died (20%), the causes were ARDS, brain hemorrhage and hypovolemic shock.
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PMID:[Severe pre-eclampsia and HELLP syndrome]. 782 29

An atypical case of HELLP syndrome is reported. The case is unique in that the patient lacked the usual symptoms and signs of hypertension, abdominal right upper quadrant pain, and tenderness. Early detection and immediate delivery resulted in a successful outcome.
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PMID:An atypical case of hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome. 790 61


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