HELLP Syndrome: CT Evaluation

Minakami, Hisanori; Sugimoto, Hideharu; Manaka, C.; Takahashi, Tsutomu; Sato, Ikuo; Tamada, T

doi:10.1159/000292440

Cited by 15 publications

(7 citation statements)

References 10 publications

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“…The most serious complication of HELLP syndrome is a hepatic rupture (incidence approx. It is fundamentally advisable that patients with persistent upper quadrant pain or pain in the shoulder area, as well as tenderness in the region of the liver especially in connection with additional phases of hypotension, should undergo a careful ultrasonography of the upper abdomen which, as oppose to a liver CT, presents greater prognostic accuracy regarding the development of HELLP syndrome [29]. Liver ruptures have been reported between 18 weeks gestation and three days postpartum affecting, predominantly, the anterior-superior aspect of the right hepatic lobe [19].…”

Section: Clinical Course Maternal and Infant Mortalitymentioning

confidence: 99%

HELLP Syndrome

Rath¹,

Faridi²,

Dudenhausen³

2000

Journal of Perinatal Medicine

133

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HELLP syndrome is a serious, life-threatening form of pre-eclampsia with a typical laboratory triad. The incidence of the disease is reported as being 0.17-0.85% of all live births. There has been, to date, neither reliable early recognition nor effective prevention of HELLP syndrome. As a result of endothelial dysfunction, activation of intravascular coagulation occurs with fibrin deposition in the capillaries and consecutive microcirculation disorders. The disease manifests itself on average between 32-34 weeks' gestation. HELLP syndrome will occur postpartum in up to 30% of the cases. The clinical cardinal symptom of the disease is right upper quadrant pain or epigastric pain accompanied with nausea, vomiting and malaise. In 20% of the cases with HELLP syndrome there is no hypertension and 5-15% of the pregnant patients present a low level of proteinuria or none at all. The early recognition of hemolysis is most sensitively managed by the determination of the serum haptoglobin. The increase of the aspartate transaminase (AST) and the alanine transaminase (ALT) often precedes a decrease in platelets. The course of HELLP syndrome is incalculable. It is universally agreed that a pregnancy from 32-34 weeks should be immediately delivered. Before 32-34 weeks, expectant management is generally possible in a perinatal center. The frequency for a repeated hypertensive disease in pregnancy ranges from 27% to 48%.

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Section: Clinical Course Maternal and Infant Mortalitymentioning

confidence: 99%

HELLP Syndrome

Rath¹,

Faridi²,

Dudenhausen³

2000

Journal of Perinatal Medicine

133

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“…Antithrombin III (AT‐III) is the major physiologic inhibitor of blood coagulation (1). AT‐III activity is not thought to significantly change during uncomplicated pregnancies (2–5), although decreased AT‐III activity is seen in women with preeclampsia (3–5), syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome) (6–8), and acute fatty liver of pregnancy (9–11). Similarly, platelet counts do not exhibit significant changes during uncomplicated pregnancies (12,13).…”

mentioning

confidence: 99%

Antithrombin III activity and platelet count are more likely to decrease in twin pregnancies than in singleton pregnancies

Tsunoda

Ohkuchi

Izumi

et al. 2002

Acta Obstet Gynecol Scand

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“…Although the AST values in these patients were somewhat lower than those seen in previous cases of the HELLP syndrome, the clinical features and changes in laboratory variables, including antithrombin III activity [11,15] and the LDH level [16,17], were similar to those of the HELLP syndrome. It is possible that our patients exhibited only a slight increase in AST because of our early intervention policy, which is based on our earlier experience [18][19][20][21]. The thrombocytopenia and liver dysfunction seen in the HELLP syndrome resolve soon after delivery [11,16].…”

Section: Discussionmentioning

confidence: 97%

Relation between Gestational Thrombocytopenia and the Syndrome of Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP Syndrome)

Minakami

Kohmura²,

Izumi³

et al. 1998

Gynecol Obstet Invest

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Objective: To define the clinical features of gestational thrombocytopenia and to determine its relationship to the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome). Study Design: Retrospective cohort study. We reviewed the records of 24 women with gestational thrombocytopenia among 637 nonpreeclamptic women who had serial determinations of the platelet count during pregnancy between 1992 and 1995. Gestational thrombocytopenia was defined as an antenatal gradual decline in the platelet count to <150 × 10⁹/l in nonpreeclamptic women. The control group consisted of 213 nonpreeclamptic women whose platelet counts were ≥150 × 10⁹/l at –3 to 0 days from delivery and in whom the perinatal serum level of aspartate transaminase (AST) had been determined. Results: The platelet count decreased gradually, from 210 ± 31 × 10⁹/l at <13 weeks’ gestation to 127 ± 24 × 10⁹/l at –3 to 0 days from delivery, in the 24 women with gestational thrombocytopenia. The platelet count was 251 ± 62 × 10⁹/l at –3 to 0 days from delivery in the 213 control women. The serum level of AST was elevated perinatally in 5 (21%) of 24 women with gestational thrombocytopenia compared with 6 (2.8%) of the 213 control subjects (p < 0.001). There had been 28 previous term or near-term pregnancies among 17 women with gestational thrombocytopenia, 14 of which were complicated by gestational thrombocytopenia or a decline in the platelet count by >50 × 10⁹/l; 1 pregnancy was associated with the features typical of the HELLP syndrome. Conclusion: Gestational thrombocytopenia may be a risk factor for the development of the HELLP syndrome and is likely to recur in subsequent pregnancies.

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HELLP Syndrome: CT Evaluation

Cited by 15 publications

References 10 publications

HELLP Syndrome

HELLP Syndrome

Antithrombin III activity and platelet count are more likely to decrease in twin pregnancies than in singleton pregnancies

Relation between Gestational Thrombocytopenia and the Syndrome of Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP Syndrome)

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