产前HELLP综合征并发可逆性后部白质脑病综合征一例

HELLP综合征及可逆性后部白质脑病综合征（reversible posterior leukoencephalopathy syndrome,RPLS发病机制尚不清楚,治疗缺少临床指南的统一指导。报告1例产前HELLP综合征并发RPLS患者,产前以头痛、失明为主要临床表现,血压升高,辅助检查提示乳酸脱氢酶、丙氨酸转氨酶及天冬氨酸转氨酶升高,血小板下降,急诊子宫下段剖宫产术后发生寒战、抽搐,时有烦躁不安等谵妄症状,予镇痛、镇静、降压、利尿、抗感染和保肝等对症治疗,10 d后病情稳定,视力恢复正常,血压控制平稳。对于妊娠期高血压疾病患者,出现神经、视觉障碍症状者需考虑合并RPLS的可能性,尽早诊断及治疗,保障母婴安全。     

产后HELLP综合征、子痫并发可逆性后部脑病综合征一例

HELLP综合征以溶血、肝酶水平升高及血小板计数降低为特点,在妊娠期发生率为0.5%~0.9%,约70%发生在产前,大部分发生在妊娠晚期,但有30%的病例发生在产后,通常是在产后48 h内确诊。本文报道1例产前无妊娠期高血压疾病表现,因产后HELLP综合征、子痫及可逆性后部脑病综合征（PRES）入院的患者,该患者顺产后...     

子痫并发HELLP综合征2例报告

1982年Weinstin将妊高征并发微血管病性溶血(hemolysis)、肝酶升高(elevated liver enzyme)、血小板减少(low platelets)命名为HELLP综合征。HELLP综合征病情凶险，诊断处理不及时，对母儿的危害极大，孕产妇及围生儿死亡率极高，属于产科危重症之一。我院诊治成功2例，现报道如下。     

妊娠期及产后可逆性后部白质脑病综合征10例临床分析

目的探讨妊娠期并发可逆性后部白质脑病综合征患者的临床表现、实验室检查及影像学表现的特点。方法对2009年1月至2011年12月在首都医科大学宣武医院住院的10例妊娠期及产后并发可逆性后部白质脑病综合征患者的临床表现、实验室检查及影像学资料进行分析。结果10例患者均有意识障碍,9例患者首发症状为头痛,7例患者出现抽搐及视物模糊。10例患者的血乳酸脱氢酶（LDH）及尿酸（UA）均有不同程度的升高,其中2例病情最严重患者LDH高达1361U／L及2058U／L。10例患者头颅CT或MRI提示脑后部（双顶枕叶）低密度灶,8例患者提示脑沟回饱满,脑室系统缩小,1例重症患者大部分脑组织受累,并以脑白质密度减低为主。结论妊娠期和产后可逆性后部白质脑病综合征有其特征性的影像学改变,对于妊娠期及产后出现头痛意识障碍者应尽早做CT或MRI检查,可以早诊断,及时治疗,以取得良好预后。     

子痫前期-子痫致可逆性后部白质性脑病综合征5例分析

可逆性后部白质性脑病综合征(reversible posterior leu-koencephalopathy syndrome,RPLS)是一组最近被提出的一种临床-放射学综合征,其主要病因是高血压病.在产科,有时可见于妊娠期高血压疾病、子痫前期及子痫的患者[1].以头痛、癫痫发作、视觉障碍、意识障碍以及精神异常为主要临床表现[2].临床诊断闲难,常亏其他腑血管意外,脑卒中等相混淆,处理不当会导致患者昏迷甚至死亡.现将我院2005年6月至2008年3月经临床及影像学检查符合RPLS诊断的5例回顾性分析如下.     

先兆子痫、子痫并发可复性后部脑病综合征的临床分析

可复性后部脑病综合征(posterior reversible encephalopathy syndrome,PRES)是一系列临床和影像学表现的总称.临床主要表现为头痛、意识模糊、视力异常、癫痫发作甚至昏迷.及时正确的治疗,绝大多数患者的症状、体征、头部神经影像学检查能够恢复到病前水平,如不能得到及时正确的诊断及治疗可使病情加重甚至危及生命.     

HELLP综合征1例

患者 2 9岁 ,住院号 2 2 2 89,孕 2产 1。妊娠 3 3周 ,1个月前双下肢水肿 ,1周前自觉头晕 ,9ｈ前出现上腹部疼痛 ,继之出现抽搐 ,共 2次 ,间隔 3 0ｍｉｎ ,伴有恶心、呕吐。于2 0 0 2年 2月 10日入院。既往无高血压、肝炎病史。查体 :ＢＰ 2 1 3 / 14 7ｋＰａ ,Ｐ 96/ｍｉｎ ,Ｒ 2 0 /ｍｉｎ ,神志清 ,巩膜及周身皮肤黄染 ,心肺检查未见异常 ,肝脾不大 ,无触痛 ,腹水征阴性 ,双下肢水肿 (++) ,腹围 84ｃｍ ,宫高 2 8ｃｍ ,胎心率140 /ｍｉｎ ,先露为头 ,未衔接。实验室检查 :Ｈｂ 143 ｇ/Ｌ ,ＰＬＴ43× 10 9/Ｌ ,ＭＰＶ 9 2ｆＬ ,ＷＢＣ 2 …     

产前子痫并发HELLP综合征1例救治体会

目的：探究产前子痫并发HELLP综合征的临床救治方法及疗效。方法：选取我院2014年2月收治的产前子痫HELLP综合征患者1例,采取有效的救治方法,观察疗效。结果：患者确诊为HELLP综合征,通过实施可靠的救治方法,术后经大剂量激素以及支持对症治疗,患者15天治愈出院,新生儿情况良好。结论：早期正确诊断、早治疗是提高治愈率、降低围生期病死率的关键。     

HELLP综合征9例报告

HELLP综合征(溶血、肝酶升高、血小板减少)是重度妊高征的严重并发症之一。1982年由Weinstein首次命名，Sibai报告其发病率为重度妊高征的4％～12％，孕妇及围产儿死亡率明显升高。现将我院近6年来9例HELLP综合征的诊治情况报道如下。     

子痫前期并发HELLP综合征及微血管病变的诊治

HELLP综合征主要病理生理表现为全身小动脉痉挛、微血管病变,一旦发生会危及母儿生命。加强围生期监护、解痉、糖皮质激素治疗和适时终止妊娠等尤为重要。     

HELLP综合征合并肝梗死引起产妇死亡一例及文献复习

肝梗死是一种极其罕见的致命并发症,与溶血、肝酶升高和低血小板水平为特点的HELLP综合征有关.该病可以由急性肝衰竭发展而来,增加产妇和新生儿死亡率.报告1例38岁女性,既往有妊娠期高血压病史,在妊娠31+3周分娩后发生HELLP综合征.随后发生多器官功能衰竭,尽管用血浆置换以及各种对症治疗,但患者病情逐渐恶化并出现脓毒...     

Acute Pancreatitis and Cholecystitis Associated with Postpartum HELLP Syndrome: A Case and Review

We report a case of preeclampsia associated with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome and concomitant nonbiliary acute pancreatitis and cholecystitis in the first postpartum day. A thorough investigation ruled out known etiologies of both pancreatitis and cholecystitis. Following conservative treatment, the patient's HELLP syndrome, pancreatitis, and cholecystitis resolved on the third postpartum day. Preeclampsia is associated with microvascular abnormalities that may involve the splanchnic circulation. These abnormalities may cause not only HELLP syndrome but also pancreatitis and cholecystitis. Recognizing that ischemia can damage not only the liver but also the pancreas and gallbladder, could result in improvements in the diagnosis and management of pancreatitis in patients with preeclampsia.     

重度子痫前期及子痫发生可复性后部脑白质综合征的MRI特点及临床分析

目的:探讨重度子痫前期及子痫发生可复性后部脑白质综合征(posterior reversible en-cephalopathy syndrome,PRES)的磁共振成像(MRI)特点和临床特点.方法:对26例重度子痫前期患者和14例子痫患者进行脑部MRI检查,根据MRI检查结果将患者分为PRES组和对照组.并对病变的部位及病变的信号特点、临床症状、血压及实验室检查特点进行分析.结果:①MRI检查40例患者,其中MRI显示正常的患者12例(对照组),MRI显示PRES患者26例(PRES组),脑梗死患者1例、颅内静脉窦血栓患者1例;②PRES组MRI表现为皮层和皮层下病变.呈现T1W信号增强和T2信号减弱.病变部位表现为:枕叶均受累及,其次为项叶、额叶和颞叶,少数累及基底节和脑桥;③PRES组与对照组相比,临床症状中抽搐发生率前者高于后者;同时前者血浆尿酸水平也高于后者.结论:可复性后部脑病综合征是重度子痫前期及子痫发生脑病的主要特征性损害,推测与内皮细胞损伤有关的血脑屏障受损可能在发病中起重要作用.     

Hydrocephalus after Intraventricular Hemorrhage in Eclamptic Woman with HELLP Syndrome

We report the first case of an obstructive hydrocephalus after intraventricular hemorrhage in a woman with HELLP syndrome and eclampsia. A 25-year-old primiparaous woman had severe preeclampsia at 36 weeks of gestation. She complained of epigastric pain and nausea. The levels of AST, ALT, and LDH were 539, 560, and 1051 IU/L, respectively; the platelet count was 101 × 10⁹/L. Cesarean section was promptly performed. Intraoperatively, she had a first convulsion. The CT scan revealed only mild brain edema. The platelet count deteriorated to 30 × 10⁹/L at 5 hour after the operation, and she had a second convulsion with an intraventricular hemorrhage. On the 6^th post-cesarean day, she complained severe headache followed by coma. The CT scan revealed the enlargement of both lateral ventricles, indicating the occurrence of obstructive hydrocephalus. Drainage into cerebral ventricle was performed, resulting in the recovery of consciousness to a normal level.     

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.     

Characteristic Laboratory Changes in Pregnancies Complicated by HELLP Syndrome

Introduction: HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) is a severe, life-threatening form of preeclampsia. Its development is accompanied by significant increase in maternal, as well as fetal, morbidity, and mortality rates. It is essential, therefore, for obstetricians to be familiar with the disease. Materials and Methods: In the past 10 years, 107 patients were treated for HELLP syndrome in the intensive care unit (ICU) of the First Department of Obstetrics and Gynaecology, Semmelweis University. During this time, we studied the characteristic laboratory findings of the disease from the day of the diagnosis until the first few postpartum days. Results: HELLP syndrome was present in 0.37% of all women having live births. In our study, the liver enzymes AST, and LDH, and the level of total bilirubin (indicating the degree of hemolysis), and repeated thrombocyte counts were suitable for following the cases. The AST, LDH and bilirubin levels returned to normal between the third and seventh days postpartum. The platelet count passed the critical level of 100,000/μL on the third to fourth day. Conclusions: We have found that the platelet count, LDH, AST, and total bilirubin levels proved to be useful indicators of the progression of HELLP syndrome.     

HELLP Syndrome: 8 Years of Experience from a Tertiary Referral Center in Western Turkey

Objective. This study was performed to determine the incidence, symptomatology, complications, mode of delivery, treatment modalities, and risk factors for maternal outcome and perinatal outcome in women with HELLP syndrome. Methods. A total of 303 pregnancies with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome diagnosed antenatally were reviewed between 2002 and 2009. Demographic data, including age, parity, gestational age, and clinical and laboratory findings, were recorded from the medical files. In addition, delivery route, indication of cesarean section, and fetal and maternal complications were determined. Results. Acute renal failure (20.5%) was the most common complication. Eclampsia was present in 303 women with HELLP syndrome (52%). There were four maternal deaths (1.4%). The perinatal mortality rate was 20.3%. The percentages of intracerebral hemorrhage and maternal death were higher in women with eclampsia than in those without (6.3% vs. 0.8%, p = 0.01 and 4.8% vs. 0.4%, p = 0.02, respectively). A nadir platelet count of ≤50,000 cells/mm³, a peak serum AST of >150 IU/L, and a peak serum LDH of ≥1400 IU/L were not independent risk factors of an adverse outcome. Conclusion. We concluded that the incidence rates of serious maternal and fetal morbidities and mortalities are increased in HELLP syndrome. Laboratory parameters of HELLP syndrome are not independent risk factors for adverse neonatal–maternal outcome. Adequate and prompt diagnosis and management are crucial in patients with HELLP syndrome.     

Retinal detachment in association with pre-eclampsia, eclampsia, and HELLP syndrome

Objective

To review case reports of retinal detachment in women with pre-eclampsia/eclampsia.

Methods

Medline was searched for case reports of retinal detachment associated with pre-eclampsia/eclampsia. Articles written in English, Spanish, or Portuguese and published between 1990 and 2010 were reviewed.

Results

A total of 28 cases of retinal detachment were identified; 15 were associated with severe pre-eclampsia (3 of these probably had hemolysis, elevated liver enzymes, and low platelets [HELLP] syndrome), 9 with HELLP syndrome, 2 with eclampsia, and 2 with both HELLP syndrome and eclampsia. The majority (60%) of women were nulliparous, 4 had abruptio placentae, and cesarean delivery was performed in 76%. Retinal detachment was bilateral in 89% and associated with delivery of the fetus in 96%; 69% were diagnosed postpartum. Within 2-12 weeks postpartum, all patients had complete recovery of vision with clinical management.

Conclusion

Retinal detachment in pre-eclampsia/eclampsia might be associated with HELLP syndrome, indicating that microangiophatic hemolysis might have a role in the pathophysiology of retinal detachment. Its occurrence might not be correlated with the severity of pre-eclampsia because pre-eclampsia is a constellation of signs and symptoms (persistent vasospasms with hemolysis and hypoalbuminemia) rather than simply being hypertension.