Transient postpartum diabetes insipidus in twin pregnancy associated with HELLP syndrome

Diabetes insipidus during pregnancy is an uncommon medical problem, and its cause is not entirely clear. We present a woman with twin pregnancy associated with HELLP syndrome, who developed diabetes insipidus during postpartum period. A hypertonic saline infusion study with measurement of plasma arginine vasopressin concentrations confirmed the diagnosis. She had mild response to 1-desamino-8-d-arginine-vasopressin (dDAVP) during the immediate postpartum period. On the 3rd postpartum day two doses of 100 microliters of dDAVP were administered, and her urinary volume gradually decreased. We could stop dDAVP on the 30th postpartum day. This exacerbation may result from increased vasopressinase activity caused by the excessive production in the placenta due to twin pregnancy, together with the insufficient degradation in the liver due to HELLP syndrome.     

Dexamethasone compared with betamethasone for glucocorticoid treatment of postpartum HELLP syndrome

Objectives: To compare the efficacy of dexamethasone and betamethasone to ameliorate the course of postpartum hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. Methods: A prospective, mixed randomized/non-randomized clinical investigation of patients with postpartum HELLP syndrome. Treatment with either dexamethasone or betamethasone was continued until there was evidence of disease recovery. Results: Baseline characteristics of both the dexamethasone (n=18) and betamethasone (n=18) groups were similar. Although the time to discharge from the obstetrical recovery room was not statistically significant between groups, reduction in mean arterial blood pressure was more pronounced in the dexamethasone group as compared with the betamethasone group (−15.3±1.4 mmHg vs. −7.5±1.4 mmHg, respectively, P<0.01). Patients in the dexamethasone group required less antihypertensive treatment than the betamethasone group (6% vs. 50%, P=0.01) and also had a decreased need for readmission to the obstetrical recovery room (0% vs. 22%, P=0.03). Conclusion: This investigation supports the use of dexamethasone as the superior glucocorticoid to use for patients with postpartum HELLP syndrome.     

Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome with pituitary apoplexy

After hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome was diagnosed in a 35-year-old woman at 39 weeks' gestation, magnetic resonance imaging and hormone examination revealed pituitary apoplexy with panhypopituitarism and diabetes insipidus. Evaluation of pituitary function should be considered in patients with HELLP syndrome.     

Comparisons of maternal and perinatal outcomes in Taiwanese women with complete and partial HELLP syndrome and women with severe pre-eclampsia without HELLP

AIM: To analyze the variations between maternal complications and perinatal outcome among women with complete hemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome, partial HELLP syndrome, and women with severe pre-eclampsia and normal laboratory tests. We also examine the effect of corticosteroid therapy for treatment of HELLP. METHODS: In this retrospective study, six patients with complete HELLP syndrome and 46 with partial HELLP syndrome, were compared and contrasted with 212 patients with severe pre-eclampsia but without HELLP syndrome. RESULTS: In Protocol 1, multiple organ dysfunction syndrome (MODS) was the strongest morbidity factor associated with patients among complete HELLP, partial HELLP, and severe pre-eclampsia. After post-hoc analysis, disseminated intravascular coagulation (DIC) was the significant outcome variable between complete and partial HELLP. In Protocol 2, after adjustment, we found that MODS (adjusted OR, 15.2, 95% CI, 6.18-35.53; P < 0.001); Apgar score less than 5 at 1 minute (adjusted OR, 2.17, 95% CI, 0.94-5.01; P = 0.069) and DIC (adjusted OR, 9.51, 95% CI, 1.68-53.7, P = 0.011) remained significantly associated with HELLP syndrome. There was a favorable outcome found in the complete HELLP group. Neither the dexamethasone group nor the aggressive therapy group could benefit from the treatment protocol. CONCLUSION: The different categories of HELLP syndrome, the protocol 1 and protocol 2 have been noted as differential effects on pregnancy outcome. MODS and DIC would be two significant outcome variables and corticosteroid therapy may not benefit HELLP patients.     

Transient postpartum diabetes insipidus

Diabetes insipidus may first present before, during, or immediately after pregnancy. The characteristics of two unusual cases of transient postpartum diabetes insipidus are described and discussed.     

Atypical case of reversible posterior leucoencephalopathy syndrome associated with puerperal HELLP syndrome

Reversible posterior lekoencephalopathy syndrome (RPLS) is usually reversible. However, permanent cerebral damage may result if diagnosis is delayed. White matter edema in the posterior cerebral hemispheres is typical on neuroimaging. A 36-year-old primigravid woman underwent induction of labor due to mild pregnancy-induced hypertension. At 5 h after delivery, she developed eclampsia seizures complicated by hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. Magnetic resonance imaging showed high-density lesions in anterior regions without any abnormalities in posterior cerebral regions. Cases of postpartum RPLS without involvement of posterior brain regions after eclampsia complicated by HELLP syndrome are very rare. Patients with RPLS do not always show typical manifestations.     

Embryonal sarcoma of the liver in pregnancy, associated with HELLP syndrome

After cesarean section, a 30-year-old patient with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count in association with preeclampsia) had fever, jaundice, loss of ascites, and a cardiac murmur. Magnetic resonance imaging showed a tumor extending from the left lobe of the liver into the inferior vena cava, right atrium, and ventricle. The biopsy specimen revealed an embryonal sarcoma of the liver. On the second day of chemotherapy, the patient died of intra-abdominal hemorrhage from the tumor.     

妊娠并发HELLP综合征66例临床分析

目的探讨妊娠并发HELLP综合征的临床特点及孕产妇和围产儿的预后。方法回顾性分析2005年1月至2009年12月在广州医学院附属第三医院妊娠合并HELLP综合征66例,比较完全性和部分性HELLP患者的实验室指标、入院孕周、终止妊娠时机、围产儿缺氧、出生体重及死亡率等。结果实验室指标:完全性HELLP组血小板计数明显低于部分性HELLP组(P<0.05),乳酸脱氢酶(1651.8±1058.9)U/L则显著高于部分性HELLP组(478.3±266.6)U/L(P<0.05);天冬氨酸转氨酶及总胆红素两组间亦存在显著统计学差异(P<0.05)。完全性HELLP组的分娩孕周为(33.7±4.0)周,新生儿体重(1723.8±546.1)g,死亡率为14.3%;部分性HELLP组的分娩孕周为(34.2±4.2)周,新生儿体重(1831.2±949.3)g,死亡率为14.3%,两组间无统计学差异(P>0.05)。结论完全性HELLP综合征和部分性HELLP综合征在实验室指标、临床表现方面均有显著不同。如能早期诊断、早期支持治疗并应用糖皮质激素,依据病情的严重程度及孕周,及时终止妊娠,新生儿的预后无显著差异。     

产后HELLP综合征合并多器官功能障碍综合征:1例病案报道

目的探讨连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)对HELLP综合征(hemolysis,elevated liver enzymes,and low platelets syndrome)的治疗作用。方法对1名40岁,第二次自然妊娠,双胎,剖宫产后大出血随后发展为HELLP综合征并出现多器官功能障碍综合征(MODS)的女性患者,进行院内ICU救治并给予连续性肾脏替代治疗(CRRT)。结果经治疗36 d后,患者好转出院,后电话随访,未再出现相关不适症状。结论肾上腺糖皮质激素及CRRT的应用提高了HELLP综合征患者的生存率及生活质量,但应用的时机和剂量还需要大规模的研究。     

Postpartum spontaneous rupture of a liver hematoma associated with preeclampsia and HELLP syndrome

We report the case of a 28-year-old nulliparous woman who presented at 36 weeks’ gestation with preeclampsia: high blood pressure, proteinuria and edema. Serum test results were normal and platelet count was 155 × 10³/mm³. After 30 h the patient initiated severe epigastric pain and vomits, and lab tests presented a slight increase in liver enzymes. The platelet count remained above 150,000/μL. Cesarean section (CS) was performed. Six hours after CS, she developed a hypovolemic shock and lab tests became increasingly abnormal (liver enzymes increased sharply and hemoglobin and platelet count decreased sharply). Abdominal ultrasound showed suggestive signs of hepatic rupture. The patient was stabilized and exploratory laparotomy was performed. Perihepatic packing was applied. The patient was discharged after 25 days of admission (15 days at the ICU) and three explorative laparotomies. This case highlights the unpredictability of this event based on the changes of liver enzyme values, LDH and platelet count. These changes only occurred when the rupture had already occurred and the patient was in hypovolemic shock.     

Posterior reversible encephalopathy syndrome in a patient with HELLP syndrome complicating a triploid pregnancy

Posterior reversible encephalopathy syndrome (PRES) is a rare-and not always reversible-neurological complication associated with pre-eclampsia. We report a highly unusual case of puerperal PRES occurring in the context of pre-eclampsia arising from a previously undiagnosed triploid pregnancy at 16 weeks gestation.     

HELLP综合征30例临床分析

目的分析30例HELLP综合征的临床表现及母儿结局,探讨该病目前的诊治和预后. 方法对30例HELLP综合征进行回顾性分析,其中完全性HELLP 19例,部分性HELLP 11例,比较两组的实验室指标、临床表现、母儿并发症和分娩结局. 结果完全性HELLP组的乳酸脱氢酶值为(622±481)U/L,显著高于部分性组(369±101)U/L(P<0.05);而其他各实验室指标两组间无统计学差异.完全性HELLP组中、重度妊高征占84%(16/19),有特殊表现病例占63%(12/19),部分性HELLP组中、重度占36%(4/11),有特殊表现病例占18%(2/11),两组有显著性差异(P<0.05).两组围产儿死亡率无统计学差异(完全性组20.0%,部分性组9.1%,P>0.05).完全性HELLP组的分娩孕周为(32±4)周,新生儿体重(1617±603) g;部分性组的分娩孕周为(36±3)周,新生儿体重(2381±786) g,两组比较差异有显著性(P均<0.05).两组剖宫产率为95%(完全性组)和73%(部分性组),差异无显著性(P>0.05).产后HELLP综合征者2例,均为完全性.两组患者的血小板和肝功能均于产后24 h开始恢复,产后72 h血小板恢复正常,产后第5天肝功能恢复正常. 结论完全性HELLP综合征的临床病情较部分性更加严重.但如能及时诊治,二者的预后(包括实验室指标的恢复和围产儿死亡率)无显著差别.     

Severe,early-onset hemolysis,elevated liver enzymes,and low platelet (HELLP) syndrome episode with spontaneous remission during pregnancy

A case of a severe HELLP syndrome episode at 21 + 0 weeks of gestation is reported. Expectant management resulted in rapid improvement of all HELLP parameters. Subsequently preeclampsia developed and uteroplacental dysfunction deteriorated. Intrauterine fetal death occured at 22 + 3 weeks of gestation.     

Is conservative treatment of HELLP syndrome safe?

HELLP syndrome is associated with a high rate of maternal and perinatal morbidity and mortality, and often leads to immediate fetal extraction. However, this condition may occur very early in pregnancy and conservative approaches have been recently proposed. The limits of this approach are discussed with two cases of conservative management of HELLP syndrome complicated by abruptio placentae.     

HELLP综合征14例临床分析

目的 探讨产科并发症HELLP综合征的母儿预后。方法 回顾性分析研究14例HELLP综合征的患者妊娠结局和围产儿预后。结果 14例中12例发生在产前，2例发生在产后，平均孕龄为32．5周，孕妇的严重并发症包括：急性肾衰、DIC、肺水肿、严重腹水和胎盘早剥等。其中8例需要输血或血液制品，12例采用剖宫产结束分娩。围产儿死亡5例，主要与胎盘早剥有关，另外胎儿宫内窘迫及早产也是重要原因。结论 HELLP综合征是一种严重的产科并发症，其高的母婴并发症和病死率要求我们对有妊娠高血压疾病的患者进行密切随访和治疗，一旦确诊为HELLP综合征应转入中心级以上医院进行治疗，尽快终止妊娠。