Placental abruption as a trigger of DIC in women with HELLP syndrome: a population-based study

Gomez-Tolub, Rachel; Rabinovich, Alex; Kachko, Eric; Benshalom-Tirosh, Neta; Tirosh, Dan; Thachil, Jecko; Besser, Limor; Than, Nándor Gábor; Erez, Offer

doi:10.1080/14767058.2020.1818200

Cited by 13 publications

(8 citation statements)

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“…The occurrence of HELLP syndrome can be accompanied by irreversible damage to organs, often complicated by adverse symptoms such as placental abruption, resulting in adverse pregnancy outcomes ( 18 ). This study analyzed the pregnancy outcomes of women with SPE complicated by HELLP syndrome.…”

Section: Discussionmentioning

confidence: 99%

Clinical Classification, Pregnancy Outcomes and Risk Factors Analysis of Severe Preeclampsia Complicated With HELLP Syndrome

et al. 2022

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PurposeTo investigate the clinical classification, pregnancy outcomes and risk factors of pregnant women with severe preeclampsia (SPE) complicated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.MethodsThe clinical data of 50 pregnant women diagnosed with SPE complicated with HELLP syndrome in our hospital from January 2014 to January 2021 were retrospectively analyzed, and they were selected as the observation group. An additional 50 maternities diagnosed with preeclampsia (PE) during the same period were selected as the control group. The clinical classification and pregnancy outcomes of pregnant women in the observation group were recorded. The age and gestational age of onset of pregnancy were recorded and compared between the two groups. Univariate analysis and multivariate logistic regression model were used to analyze the risk factors for its occurrence.ResultsAmong the 50 maternities in the observation group, there were 10 cases of type I, accounting for 20.00%; 35 cases of type II, accounting for 70.00%; 5 cases of type III, accounting for 10.00%. Partial 33 cases, the composition ratio of 66.00%; complete 17 cases, the composition ratio of 34.00%. Among the fetuses of 50 maternities in the observation group, 35 were premature, accounting for 70.00%; 13 had fetal growth restriction, accounting for 26.00%; and 2 died during perinatal period, accounting for 4.00%. Among the 50 maternities in the observation group, 48 cases were cesarean section, the composition ratio was 96.00%; 2 cases were induced labor, the composition ratio was 4.00%; there was no natural birth, the composition ratio was 0.00%. Univariate analysis showed that age, gestational age at onset, gestational age at termination of pregnancy, HGB, LDH, ALT, AST, TBIL, PLT, PT, and FIB were all associated with the occurrence of SPE complicated with HELLP syndrome (P < 0.05). Multivariate logistic analysis showed that gestational age at onset, gestational age at termination of pregnancy, HGB, LDH, ALT, AST, TBIL, PLT, and FIB were independent risk factors for SPE complicated with HELLP syndrome (P < 0.05).ConclusionSPE complicated with HELLP syndrome has significantly increased adverse pregnancy outcomes. Understanding its clinical classification is of great significance for the preventive application of platelet transfusion therapy and the selection of transfusion timing. Gestational age at onset and gestational age at termination of pregnancy are independent risk factors for its occurrence. Fully understanding the high-risk factors of HELLP syndrome, taking preventive measures in time, and carrying out targeted nursing can effectively improve the prognosis of pregnant women and reduce the risk of HELLP syndrome.

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Section: Discussionmentioning

confidence: 99%

Clinical Classification, Pregnancy Outcomes and Risk Factors Analysis of Severe Preeclampsia Complicated With HELLP Syndrome

et al. 2022

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“…Overt disseminated intravascular coagulation (DIC) is uncommon in preeclampsia or eclampsia alone, but it occurs in 6% to 32% of patients with HELLP. 97,117,118 Abdominal ultrasound is indicated to assess liver size, patency of hepatic vasculature, and signs of portal hypertension. Hepatic dysfunction in preeclampsia is characterized by elevated aminotransferase levels, with AST initially higher than ALT, possibly related to the centrizonal nature of liver injury and a contribution from hemolysis in cases complicated by HELLP.…”

Section: Diagnosis Clinical Presentationmentioning

confidence: 99%

Pregnancy-Associated Liver Diseases

Terrault

Williamson

2022

Gastroenterology

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“… 79 Recent advances in the understanding of the mechanisms of DIC in HELLP syndrome suggest that abruption rather than liver dysfunction is the driving force for the development of DIC in these patients. 39 Indeed, the rate of placental abruption was 5.6% in women with HELLP syndrome without DIC in comparison to 42.9% among those with DIC, 39 suggesting that the main underlying mechanism leading to DIC in HELLP syndrome is related to trophoblast deportation into maternal circulation rather than to an intrinsic liver dysfunction.…”

Section: Introductionmentioning

confidence: 99%

“…Placental abruption seems to be the underlying mechanism for the development of DIC when it is associated with other obstetrical complications including fetal death and HELLP syndrome. 7,[33][34][35][36][37][38][39] Thus, pregnancy is a time point in women's life in which she is at increased risk to develop DIC as a result from different complications of pregnancy, and especially placental abruption. Prompt attention and treatment of underlying obstetrical disorders and rapid diagnosis and management of placental abruption can reduce the risk for DIC substantially.…”

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confidence: 99%

DIC in Pregnancy – Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments

Erez¹,

Othman²,

Rabinovich³

et al. 2022

JBM

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Obstetrical hemorrhage and especially DIC (disseminated intravascular coagulation) is a leading cause for maternal mortality across the globe, often secondary to underlying maternal and/or fetal complications including placental abruption, amniotic fluid embolism, HELLP syndrome (hemolysis, elevated liver enzymes and low platelets), retained stillbirth and acute fatty liver of pregnancy. Various obstetrical disorders can present with DIC as a complication; thus, increased awareness is key to diagnosing the condition. DIC patients can present to clinicians who may not be experienced in a variety of aspects of thrombosis and hemostasis. Hence, DIC diagnosis is often only entertained when the patient already developed uncontrollable bleeding or multi-organ failure, all of which represent unsalvageable scenarios. Beyond the clinical presentations, the main issue with DIC diagnosis is in relation to coagulation test abnormalities. It is widely believed that in DIC, patients will have prolonged prothrombin time (PT) and partial thromboplastin time (PTT), thrombocytopenia, low fibrinogen, and raised D-dimers. Diagnosis of DIC can be elusive during pregnancy and requires vigilance and knowledge of the physiologic changes during pregnancy. It can be facilitated by using a pregnancy specific DIC score including three components: 1) fibrinogen concentrations; 2) the PT difference -relating to the difference in PT result between the patient's plasma and the laboratory control; and 3) platelet count. At a cutoff of ≥26 points, the pregnancy specific DIC score has 88% sensitivity, 96% specificity, a positive likelihood ratio (LR) of 22, and a negative LR of 0.125. Management of DIC during pregnancy requires a prompt attention to the underlying condition leading to this complication, including the delivery of the patient, and correction of the hemostatic problem that can be guided by point of care testing adjusted for pregnancy.

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Placental abruption as a trigger of DIC in women with HELLP syndrome: a population-based study

Cited by 13 publications

References 82 publications

Clinical Classification, Pregnancy Outcomes and Risk Factors Analysis of Severe Preeclampsia Complicated With HELLP Syndrome

Clinical Classification, Pregnancy Outcomes and Risk Factors Analysis of Severe Preeclampsia Complicated With HELLP Syndrome

Pregnancy-Associated Liver Diseases

DIC in Pregnancy – Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments

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