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Hypertensive Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
The presenting symptoms are usually right upper abdominal quadrant or epigastric pain, nausea, and vomiting. Headache and visual symptoms can occur. Malaise or viral syndrome–like symptoms may be present with advanced HELLP syndrome. It is important to note that 15% have no hypertension and 13% no proteinuria (Table 1.9) [125].
Hepatic disorders in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Ghassan M. Hammoud, Jamal A. Ibdah
Pre-eclampsia develops in 5% to 11% of all pregnancy and is characterized by the triad of proteinuria (greater than 300mg in 24 hours), edema, and hypertension (>140/90 mmHg) after 20 weeks of gestation and/or within 48 hours after delivery. If the central nervous system becomes involved, for example, seizures or coma, the disorder is termed eclampsia. Hepatic involvement is a sign of advanced pre-eclampsia/eclampsia and may manifest as HELLP syndrome or hepatic rupture. The incidence of HELLP syndrome is approximately 0.6% of pregnancies and 3.1% to 12% of patients with pre-eclampsia (70). HELLP syndrome occurs mainly in the antepartum period in 70% to 92% of cases and postpartum in 8% to 30%.
Hepatobiliary system
Published in Pankaj Desai, Pre-eclampsia, 2020
One more vital organ system that bears a heavy brunt of pre-eclampsia is the liver. Epigastric pain, which is one important clinical feature of severe pre-eclampsia, is believed to be hepatic in origin. The stretching of the liver capsule with or without subcapsular haemorrhage is the most likely cause of epigastric pain in pre-eclampsia. HELLP (haemolysis, elevated liver enzymes, low platelet count) syndrome has also been found to have a consistent association with epigastric or right-upper quadrant abdominal pain. Typical clinical symptoms of HELLP syndrome are a pain in the right upper-quadrant abdomen or epigastric pain, nausea and vomiting.1 Hepatic enzymes are found to be altered consistently in pre-eclampsia in the clinical situation of HELLP syndrome. However, in the absence of this complication of pre-eclampsia, alterations in liver enzymes are not usually found.
Predictors of adverse maternal outcome in jaundiced pregnant women identified as having pregnancy-specific liver disease (P-sLD)
Published in Journal of Obstetrics and Gynaecology, 2022
Thendral Natarajan, Sasirekha Rengaraj, Latha Chaturvedula, Mukta Wyawahare
We performed a retrospective study of all pregnant women with jaundice from January 2010 to December 2018 who were admitted to JIPMER, Puducherry which is a medical college and has access to primary and tertiary health care. The details of all women were taken from the medical record retrospectively from 2010 to 2018. All women with P-sLD who had clinical jaundice (serum bilirubin of more than 1.2 mg/dl) were carefully identified and then classified into IHCP, PE, HELLP syndrome, HG and AFLP as per the standard definitions. HELLP syndrome was diagnosed in the presence of low platelet count (<100,000/mm3), jaundice/abnormal liver function and haemolysis whereas Swansea criteria were used for the diagnosis of AFLP (Knight et al. 2008). IHCP was diagnosed when the new-onset jaundice was associated with pruritus and raised bile acid and alanine transaminase (ALT) enzyme in the absence of hyperuricaemia and hypoglycaemia. Those who fit the diagnostic criteria for HELLP Syndrome, AFLP, IHCP and HG had been labelled as such and the cases which do not fulfil the diagnostic criteria had been labelled as undiagnosed. The case records of pregnant women with pre-existing liver disease, infective hepatitis, sepsis at admission and those with incomplete data were excluded from the analysis (Annexure I).
Physiological characterization of an arginine vasopressin rat model of preeclampsia
Published in Systems Biology in Reproductive Medicine, 2022
Sapna Ramdin, Thajasvarie Naicker, Virushka Pillay, Sanil D. Singh, Sooraj Baijnath, Blessing N Mkhwanazi, Nalini Govender
Liver diseases are reported to affect approximately 3% of pregnancies, resulting in maternal and fetal mortality (Mikolasevic et al. 2018), hence it is important to not rule out these variations in the liver injury enzymes. It may be potential indicators of liver dysfunction such as intrahepatic cholestasis of pregnancy or acute fatty liver of pregnancy manifesting in late pregnancy (Mikolasevic et al. 2018). This is typical in patients who present with HELLP syndrome, which is seen in severe cases of PE, however, our data indicates mild AVP induced blood pressure elevations, suggestive of mild PE onset. HELLP syndrome is a pregnancy-associated liver disease and is a predisposing factor for the progression of PE to eclampsia (Barton and Sibai 2004; Jeyabalan 2013; Brown et al. 2018). Reproducing this HELLP phenotype in animal models of PE will support the investigation of mechanisms implicated in PE development and its progression from severe PE to eclampsia.
Dysregulation of complement system in HELLP syndrome
Published in Hypertension in Pregnancy, 2021
Shi Chen, Zheng Li, Yingdong He, Qian Chen
This study included 16 patients with HELLP syndrome and 32 patients with severe preeclampsia. Based on matching the gestational age at which the blood samples were taken, 48 normal pregnant women were selected as the normal pregnancy group. The BMIs of the patients in the HELLP syndrome group and the SPE group were higher than those of the normal pregnancy group. The levels of ALT and AST in the HELLP syndrome group were higher than those in the SPE and normal pregnancy groups. The platelet counts in the HELLP syndrome group were lower than those in the SPE and normal pregnancy groups. The serum creatine levels of the HELLP syndrome and SPE groups were higher than those in the normal pregnancy group. The gestational age at delivery and fetal birth weight were lower in the HELLP syndrome and SPE groups than in the normal pregnancy group. There were three fetal/neonatal death in the SPE group, and the average birth weight of live neonates in the SPE group was higher than that in the HELLP syndrome group. The characteristics of the patients are shown in Table 1.