Postpartum HELLP syndrome complicated with large subcapsular liver hematoma

Naqvi, Syed; Hassnain, Syed; Yousaf, Amman; Muhammad, Shoaib; Cabrera, Diego

doi:10.1080/08998280.2022.2072184

Cited by 6 publications

(9 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The major pathological changes of HELLP syndrome are similar to those of pre-eclampsia, primarily manifested as systemic arteriolar spasm, endothelial cell damage resulting in collagen tissue exposure, coagulation function activation, platelet activation and aggregation to form micro-vascular thrombosis, and intravascular hemolysis causing ischemic damage of liver and other organs and tissues. The pathogenesis of HELLP syndrome remains unclear, which may comprise the interaction of multiple systems, multiple factors, and multiple mechanisms [20][21][22][23]. The main clinical manifestations of HELLP syndrome are right upper abdominal or upper abdominal pain, nausea, vomiting, general discomfort, and other non-speci c symptoms, with hidden and atypical attacks.…”

Section: Discussionmentioning

confidence: 99%

Value of proteinuria in evaluating the severity of HELLP and its maternal and neonatal outcomes

Jiao

Song

et al. 2023

Preprint

View full text Add to dashboard Cite

Background: HELLP syndrome refers to a group of clinical syndromes characterized by hemolysis, elevated liver enzymes and low platelet, and the evidence on the association between proteinuria and the severity of HELLP and its maternal and neonatal outcomes is rare. Methods: 106 pregnant women were assigned to the proteinuric group (24-hUPro ≥0.3 g, 79 cases) and the non-proteinuric group (24-hUPro<0.3 g, 27 cases). The proteinuric group was further divided into three subgroups: mild group (24-hUPro:0.3-2.0g, 33 cases), moderate group (24-hUPro:2.0-5.0g, 21 cases) and severe group (24-hUPro: ≥5.0 g, 25 cases). The general clinical data, laboratory indexes, complications and pregnancy outcome and adverse neonatal outcomes of HELLP with or without proteinuric were analyzed. Results: Compared with proteinuricgroup, the non-albuminuric group or in the three proteinuric subgroups of HELLP pregnant women's , increased proteinuria was associated with earlier onset gestations, higher incidence of abdominal pain, skin jaundice, headache, blurred vision (p < 0.05 respectively), and also the higher levels of ALT, AST, LDH, Fib, APTT, ATⅢ, proportions of tubular urine and lower levels of ALB, PLT (p< 0.05 respectively). In the three subgroups of the proteinuric group, the ratio of fetal growth restriction, cesarean section and postpartum hemorrhage were compared, and the difference was statistically significant (p < 0.05 respectively). Compared with the proteinuric group, the non-proteinuric group had higher birth weight, birth length, and lower SGA, admission rate in NICU (p < 0.05 respectively). In the three subgroups of the proteinuric group, significant differences were identified in the adverse outcomes of newborns (p < 0.05 respectively), and the incidence of adverse outcomes in neonates tended to be higher. Significant differences were identified in birth weight, birth length, and lower SGA and NICU occupancy rate among the three subgroups (p < 0.05 respectively). Conclusions: HELLP syndrome is a severe complication of pregnancy, involving multiple systems of the whole body. It has posed a great challenge to obstetricians for its acute onset, dangerous condition, rapid progress, and great harm. Thus, insights into HELLP syndrome should be gained, and early diagnosis, early treatment and timely termination of pregnancy should be conducted to reduce the incidence of maternal and fetal adverse outcomes and improve maternal and fetal prognosis.

show abstract

Section: Discussionmentioning

confidence: 99%

Value of proteinuria in evaluating the severity of HELLP and its maternal and neonatal outcomes

Jiao

Song

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Os hematomas hepáticos podem progredir para ruptura hepática com uma taxa de incidência de 1/40.000 a 1/250.000 gestações. Desse modo, devido às complicações relacionadas ao hematoma, a mortalidade materna de pacientes com essa afecção varia de 17% a 59% (Naqvi et al, 2022).…”

Section: Contextualização Da Problemáticaunclassified

“…A patogênese da formação do hematoma hepático é complexa e não é bem compreendida. Normalmente, os sintomas são inespecíficos e as pacientes podem apresentar vômitos, náuseas e dor no quadrante superior direito do abdome (Naqvi et al, 2022;Marinas et al, 2018).…”

Section: Contextualização Da Problemáticaunclassified

Prevalência E Evolução Clínica De Hematoma Hepático Na Síndrome Hellp Em Maternidade De Teresina

Valadares,

Sousa,

Martins

et al. 2024

Rev. Contemp.

View full text Add to dashboard Cite

Introdução: A síndrome HELLP é uma condição da gravidez e puerpério que ocorre em pacientes com pré-eclâmpsia, na qual o hematoma subcapsular hepático representa rara, mas grave complicação a ela associada. Sua etiopatogenia é desconhecida. No entanto, a lesão do endotélio vascular e as alterações no sistema de coagulação, presentes na doença, contribuem para o aparecimento do hematoma. Objetivo: Analisar a prevalência e a evolução clínica do hematoma subcapsular hepático em pacientes com síndrome HELLP em uma maternidade pública de referência de Teresina-PI. Metodologia: Trata-se de coorte retrospectivo no qual foram analisadas prevalência e evolução clínica do hematoma subcapsular hepático em pacientes com pré-eclâmpsia e síndrome HELLP internadas em maternidade pública de Teresina-PI, no período entre 01 de janeiro de 2019 e 31 de dezembro de 2022. Resultados: Foram selecionados prontuários de 301 pacientes, das quais 239 (79,40%) apresentaram pré-eclâmpsia, 58 pacientes (19,26%) tiveram simultaneamente pré-eclâmpsia e síndrome HELLP e 4 pacientes (1,34%) apresentaram pré-eclâmpsia, síndrome HELLP e hematoma subcapsular hepático. Considerando-se apenas as pacientes com síndrome HELLP, a prevalência é de 6,89%. Destas, 03 (75%) evoluíram com ruptura hepática e foram submetidas à laparotomia exploradora. Não ocorreu nenhum óbito. Nas pacientes submetidas ao tratamento cirúrgico, o tempo médio de internação foi de 31,66 dias; já na paciente com tratamento conservador, o tempo de internação foi de 15 dias. Conclusões: A prevalência de hematoma hepático em pacientes com síndrome HELLP foi de 6,89%. Em 03 pacientes (75%) ocorreu ruptura, tendo duas evoluído com instabilidade hemodinâmica, anemia grave e choque hipovolêmico. A abordagem cirúrgica com tamponamento hepático foi adotada nos três casos. Não ocorreram óbitos maternos.

show abstract

“…Moreover, hepatic complications such as rupture, hemorrhage, and hematomas have also been reported. One rare complication of this syndrome is subcapsular liver hematoma (SLH), which accounts for <2% of HELLP pregnancies and is associated with a maternal mortality rate of 17-59% [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…SLH results from the accumulation of blood between the liver parenchyma and the capsule of Glisson [ 4 ]. While the pathogenesis of hepatic hematoma formation is complex and not well understood, it is thought to involve fibrin deposition, leading to platelet activation, thrombus formation, and occlusion of capillaries [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

The Conservative Management of an Uncommon Case of Postpartum HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelet Count) Syndrome Complicated by Liver Hematoma Causing Gastric Outlet Obstruction: A Case Report

Garrote,

Perez-Viloria,

Caltagirone

et al. 2023

Cureus

View full text Add to dashboard Cite

Hypertensive disorders of pregnancy, particularly preeclampsia, are significant contributors to maternal and fetal mortality worldwide. HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome constitutes a severe manifestation of preeclampsia. Subcapsular liver hematoma (SLH) is a rare complication of HELLP syndrome, resulting from blood accumulation between the liver parenchyma and the Glisson's capsule. We present a unique case of a pregnant patient with HELLP syndrome complicated by SLH, leading to gastric outlet obstruction (GOO). The patient's medical history, clinical presentation, diagnostic evaluation, and management are discussed. The patient, with a history of pregnancy-induced hypertension, presented with HELLP syndrome at 34 weeks of gestation. Elevated blood pressure, liver enzymes, and low platelet count were observed. Postpartum, the patient developed SLH causing GOO. Conservative management, including intravenous fluids, pain control, and a nasogastric tube, was employed. Imaging confirmed SLH and GOO. Multidisciplinary collaboration guided the treatment approach, emphasizing close monitoring, nonoperative strategies, and dietary adjustments. The patient's condition improved, and she was discharged on postpartum day 20. This case report underscores the challenges of managing HELLP syndrome complications, especially SLH-induced GOO. Early diagnosis, appropriate medical interventions, and interdisciplinary coordination are pivotal in ensuring positive outcomes. Conservative management can be effective in stable patients, but timely recognition and monitoring remain crucial for averting potential complications. This case contributes to the limited literature on managing such complex scenarios and highlights the importance of tailored strategies in multifaceted medical conditions.

show abstract

Postpartum HELLP syndrome complicated with large subcapsular liver hematoma

Cited by 6 publications

References 13 publications

Value of proteinuria in evaluating the severity of HELLP and its maternal and neonatal outcomes

Value of proteinuria in evaluating the severity of HELLP and its maternal and neonatal outcomes

Prevalência E Evolução Clínica De Hematoma Hepático Na Síndrome Hellp Em Maternidade De Teresina

The Conservative Management of an Uncommon Case of Postpartum HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelet Count) Syndrome Complicated by Liver Hematoma Causing Gastric Outlet Obstruction: A Case Report

Contact Info

Product

Resources

About