Thrombotic thrombocytopenic purpura in 166 pregnancies: 1955-2006

Martin, James N.; Bailey, Amelia P.; Rehberg, Jonathan F.; Owens, Michelle; Keiser, Sharon; May, Warren

doi:10.1016/j.ajog.2008.03.011

Cited by 139 publications

(118 citation statements)

References 93 publications

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“…This is in accordance with a recent review of 166 pregnancyrelated TTP cases in which the median time of TTP occurrence was 23 weeks. 31 Plasma ADAMTS13 activity gradually declines throughout pregnancy from the end of the first trimester up to the end of early puerperium 6 and may reach an insufficient level to counterbalance the inhibitory effect of anti-ADAMTS13 antibodies in the late second and third trimesters. Thus, the late second and third trimesters are the gestation period with the highest risk for TTP.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy-Associated Hemolytic Uremic Syndrome Revisited in the Era of Complement Gene Mutations

Fakhouri¹,

Roumenina²,

François³

et al. 2010

Journal of the American Society of Nephrology

408

395

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In contrast to pregnancy-associated thrombotic thrombocytopenic purpura, the pathogenesis and presentation of pregnancy-associated atypical hemolytic uremic syndrome (P-aHUS) remain ill-defined. We conducted a retrospective study to assess the presentation and outcomes of patients presenting with P-aHUS and the prevalence of alternative C3 convertase dysregulation. P-aHUS occurred in 21 of the 100 adult female patients with atypical HUS, with 79% presenting postpartum. We detected complement abnormalities in 18 of the 21 patients. The outcomes were poor: 62% reached ESRD by 1 month and 76% by last follow-up. The risk for P-aHUS was highest during a second pregnancy. Thirty-five women, 26 (74%) of whom had complement abnormalities, had at least one pregnancy before the onset of a non-pregnancy-related aHUS. Outcomes did not differ between patients with pregnancy-related and non-pregnancy-related aHUS. Mutations in the SCR19-20 domains of factor H were less frequent in P-aHUS patients compared with non-pregnancy-related aHUS. Pregnancies in female patients with complement abnormalities (n ϭ 44) were complicated by fetal loss and preeclampsia in 4.8% and 7.7%, respectively. Better understanding of complement dysregulation in pregnancy complications is essential, especially to guide development of pharmacologic agents to modulate this system.

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Section: Discussionmentioning

confidence: 99%

Pregnancy-Associated Hemolytic Uremic Syndrome Revisited in the Era of Complement Gene Mutations

Fakhouri¹,

Roumenina²,

François³

et al. 2010

Journal of the American Society of Nephrology

408

395

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“…• Diagnosis of Hypertension: [11][12][13][14][15][16][17] • Measurement of Proteinuria: [18][19][20][21][22][23][24] • Classification of HDPs: [25][26][27][28][29][30][31] • Investigations to Classify HDPs: 32-37…”

Section: Recommendations Chapter 1: Diagnosis and Classification Of Tmentioning

confidence: 99%

Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy: Executive Summary

Magee

Pels²,

Helewa

et al. 2014

Journal of Obstetrics and Gynaecology Canada

544

477

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This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the SOGC.

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“…Acute fatty liver of pregnancy is managed with delivery as soon as the patient is stabilized; the latter generally involves the administration of fresh frozen plasma and other blood products for the bleeding disorder and/or severe coagulopathies, and aggressive correction of hypoglycemia and electrolyte abnormalities [103]. TTP is treated with plasma exchange or plasmapheresis [104]. CAPS during pregnancy is managed with heparin anticoagulation and prompt delivery.…”

Section: Therapy Of Lupus Flares During Pregnancymentioning

confidence: 99%

Flares of systemic lupus erythematosus during pregnancy and the puerperium: prevention, diagnosis and management

Stojan

Baer²

2012

Expert Review of Clinical Immunology

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Thrombotic thrombocytopenic purpura in 166 pregnancies: 1955-2006

Cited by 139 publications

References 93 publications

Pregnancy-Associated Hemolytic Uremic Syndrome Revisited in the Era of Complement Gene Mutations

Pregnancy-Associated Hemolytic Uremic Syndrome Revisited in the Era of Complement Gene Mutations

Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy: Executive Summary

Flares of systemic lupus erythematosus during pregnancy and the puerperium: prevention, diagnosis and management

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