Acute Onset of Severe Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome in a Patient with a Partial Hydatidiform Mole at 17 Weeks Gestation

Sherer, David M.; Dalloul, Mudar; Stimphil, Raphael; Hellmann, Mira; Khoury‐Collado, Fady; Osho, Joseph A.; Fomitcheva, Larissa; Brennan, Kelly J; Abulafia, Ovadia

doi:10.1055/s-2006-934093

Cited by 22 publications

(11 citation statements)

References 6 publications

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“…It is well established that pregnancies complicated by fetal hydrops or hydropic degeneration of the placenta (with or without a coexisting fetus, triploidy) are at very high risk for preeclampsia. 36,37 In these cases, preeclampsia usually develops in the second trimester and is usually severe and, therefore, causes substantial maternal and perinatal morbidities. The incidence of preeclampsia increases in multifetal gestation according to the number of fetuses and type of zygosity.…”

Section: Pregnancy-related Factorsmentioning

confidence: 99%

Prediction and Prevention of Recurrent Preeclampsia

Barton

Sibai

2008

Obstetrics &Amp; Gynecology

275

182

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Women with a history of previous preeclampsia are at increased risk of preeclampsia and other adverse pregnancy outcomes in subsequent pregnancies. The magnitude of this risk is dependent on gestational age at time of disease onset, severity of disease, and presence or absence of preexisting medical disorders. The objective in the management of these patients is to reduce risk factors by optimizing maternal health before conception and to detect obstetric complications as early as possible. This objective can be achieved by formulating a rational approach that includes preconception evaluation and counseling, early antenatal care, frequent monitoring of maternal and fetal well-being, and timely delivery. First-trimester ultrasound examination is essential for accurate dating and establishing fetal number. Laboratory studies are obtained to assess the function of different organ systems that are likely to be affected by preeclampsia and to establish a baseline for future assessment. Recent studies have confirmed that there is no single biomarker that can be clinically useful for the prediction of recurrent preeclampsia. Combinations of biomarkers and biophysical parameters appear promising, but more data are needed to confirm their use in clinical practice. Supplementation with fish oil, calcium, or vitamin C and E and the use of antihypertensives have been shown to be ineffective in the prevention of recurrent preeclampsia and are not recommended. Supplementation with low-dose aspirin may be offered on an individualized basis. Because women with previous preeclampsia are at increased risk for adverse pregnancy outcomes (preterm delivery, fetal growth restriction, abruptio placentae, and fetal death) in subsequent pregnancies, we recommend more frequent monitoring for signs and symptoms of severe hypertension or preeclampsia than that recommended for normal pregnancy. This monitoring may include more frequent prenatal visits, home blood pressure monitoring, or nursing contacts. For patients with a prior pregnancy complicated by preeclampsia with fetal growth restriction, we recommend serial ultrasound evaluation of fetal growth and amniotic fluid volume. The development of severe gestational hypertension, fetal growth restriction, or recurrent preeclampsia requires maternal hospitalization.

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Section: Pregnancy-related Factorsmentioning

confidence: 99%

Prediction and Prevention of Recurrent Preeclampsia

Barton

Sibai

2008

Obstetrics &Amp; Gynecology

275

182

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“…HELLP syndrome complicates 0.01-0.6% of pregnancies and can be considered a severe variant of preeclampsia [1]. The occurrence of HELLP syndrome diagnosed before the 20th week of gestation has been most commonly reported in association with antiphospholipid antibody syndrome (APS) or triploid chromosomal anomalies [2][3][4][5][6]. We present a case of atypical HELLP syndrome at 17 weeks and 6 days gestation with subsequent placental abruption and fetal demise.…”

Section: Introductionmentioning

confidence: 99%

HELLP Syndrome at 17 Weeks Gestation: A Rare and Catastrophic Phenomenon

Berry¹,

Iqbal²

2014

J Clin Gynecol Obstet

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HELLP syndrome is a collection of symptoms described as hemolysis, elevated liver enzymes and low platelets. HELLP syndrome complicates 0.01-0.6% of pregnancies and can be considered a severe variant of preeclampsia. The occurrence of HELLP syndrome diagnosed before the 20th week of gestation has been most commonly reported in association with antiphospholipid antibody syndrome (APS) or triploid chromosomal anomalies. A 41-year-old primigravida was admitted at 17 weeks and 6 days gestation with hypertension, proteinuria, hemolytic anemia and acute renal injury. She was diagnosed with HELLP syndrome, and subsequently suffered from an intrauterine fetal demise. After delivery, the clinical manifestations of HELLP syndrome resolved within 7 days with the exception of her acute renal failure. Interdisciplinary teams of physicians were able to exclude other imitators of preeclampsia, such as hemolytic uremic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP), APS, lupus and acute fatty liver of pregnancy. This case is difficult to diagnose, given the similar presentation of several microangiopathic hemolytic anemias. The clinical manifestations and laboratory findings of HELLP and its mimicking conditions seem as if they are mirror images of each other. However, the discrete differences in our patient presentation, clinical findings, laboratory results and overall postpartum course leave HELLP syndrome as the most consistent diagnosis. It is imperative to investigate for all possible etiologies as HELLP syndrome at 17 weeks gestation is extremely rare and mimicking conditions may require alternative management strategies.

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“…Indeed, preeclampsia occurs in 41.9% of pregnancies with partial mole 125 . The management of these cases is challenging and may require medical interruption of pregnancy if severe preeclampsia 126 or HELLP syndrome develops 127,128 . A recent report 25 indicates that angiogenic imbalances, characterized by high maternal serum concentrations of sFlt-1 and s-Eng and low circulating free-VEGF, participate in the pathophysiology of preeclampsia associated with partial mole.…”

Section: Angiogenic Imbalances In Molar Pregnancies and Partial Molementioning

confidence: 99%

Angiogenic Imbalances in the Pathogenesis of Pregnancy Complications

Espinoza

2014

Fet. Matern. Med. Rev.

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Endothelial cell proliferation and survival require continuous low levels of vascular endothelial growth factor (VEGF). The bioavailability of this angiogenic factor appears to be regulated by anti-angiogenic factors, including the soluble form of VEGF receptor 1 (sFlt-1) in the non-pregnant and pregnant states. During pregnancy a VEGF antagonist (sFlt-1) and other anti-angiogenic factors, including soluble endoglin (s-Eng), are produced by the human placenta and released into the maternal circulation; an excess of these anti-angiogenic factors can lead into angiogenic imbalances and pregnancy complications. This is important because regulation of VEGF action on angiogenic balances appears to be essential for a successful pregnancy.

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Acute Onset of Severe Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome in a Patient with a Partial Hydatidiform Mole at 17 Weeks Gestation

Cited by 22 publications

References 6 publications

Prediction and Prevention of Recurrent Preeclampsia

Prediction and Prevention of Recurrent Preeclampsia

HELLP Syndrome at 17 Weeks Gestation: A Rare and Catastrophic Phenomenon

Angiogenic Imbalances in the Pathogenesis of Pregnancy Complications

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