Hígado agudo graso del embarazo: reporte de caso / Acute fatty liver of pregnancy: case report

El hígado graso del embarazo es una patología poco frecuente en la especialidad obstétrica, cuyo diagnóstico se realiza basado en los criterios de Swansea, muchas veces es un diagnóstico que se realiza por exclusión; usualmente se presenta entre las semanas 30 y 35 del embarazo, y la cura definitiva se realiza con la interrupción expedita del mismo; con una tasa de recuperación casi del 100% si se realiza la interrupción oportuna y una tasa de mortalidad materno fetal actual del 10%. Es importante estar atentos a la ganancia ponderal de la embarazada durante el control prenatal, la epigastralgia, y los signos clínicos asociados a hipoglicemia(AU)

Fatty liver of pregnancy is a rare pathology in obstetrics, whose diagnosis is made based on the Swansea criteria, many times it is a diagnosis that is made by exclusion; It usually occurs between weeks 30 and 35, and the definitive cure is carried out with the expeditious interruption of pregnancy; with a recovery rate of almost 100% if timely interruption is made and a current maternal-fetal mortality rate of 10%. It is important to be attentive to the weight gain of the pregnant woman during prenatal control, epigastric pain, and clinical signs associated with hypoglycemia

Patología hipertensiva durante el embarazo y el producto de la concepción / Hypertensive pathology during pregnancy and the product of conception

El Hospital Nacional Dr. Mario Catarino Rivas (hospital de segundo nivel de atención), sirve como centro de atención para embarazos de alto riesgo de la zona noroccidental de Honduras; reportó 1,702 casos de trastor-nos hipertensivos del embarazo en 2017 y 2,070 casos en 2018. Se caracterizó pacientes con signos y síntomas de trastornos hipertensivos del embarazo agrupadas desde un punto de vista obstétrico, epidemiológico y clínico. Se realizó un estudio, descriptivo de corte transversal en gestantes que presentaron cefalea, cifras tensionales elevadas (≥ 140/90mmHg); registrando ausencia o presencia de proteinuria, atendidas en la emergencia de labor y parto de un hospital nacional de segundo nivel de atención en San Pedro Sula, Honduras, desde junio hasta octubre del 2019. Se incluyeron 110 pacientes de entre 18-43 años, mestizas y amas de casa, la edad gestacional promedio por fecha de ultima menstruación de 37.7 semanas; el 28.2% presentó preeclampsia severa. Las manifestaciones clínicas frecuentes fueron edema de miembros inferiores y cefalea. El 57.3% desarrolló trabajo de parto espontá-neo, la resolución del embarazo fue cesárea en el 57.3% de las gestantes. Respecto al producto de la concepción, 66.4% tenían peso normal y talla apropiada para la edad gestacional, un APGAR de 8 al primer minuto y de 9 a los 5 minutos. En este estudio, se reporta una prevalencia del 13.72% con respecto a los trastornos hipertensivos del embarazo. Particularmente en pacientes mayores de 35 años, multípara, con índice de masa corporal ≥ 32 kg/m2, presentando antecedentes de hipertensión arterial, diabetes mellitus y preeclampsia.

The National Hospital Dr. Mario Catarino Rivas (second-level care hospital), serves as a care center for high-risk pregnancies in the northwestern part of Honduras; it reported 1,702 cases of hypertensive disorders of pregnancy in 2017 and 2,070 cases in 2018. Patients with signs and symptoms of hypertensive disorders of preg-nancy were characterized grouped from an obstetric, epidemiological and clinical point of view. A descriptive cross-sectional study was carried out in pregnant women who presented headache, high blood pressure (≥ 140 / 90mmHg); registering the absence or presence of proteinuria in urine, attended in the labor and delivery emer-gency of a national hospital of second level of care in San Pedro Sula, Honduras; from June to October 2019. 110 patients between 18-43 years old, mixed race and housewives were included, the average gestational age by date of last menstruation of 37.7 weeks, 28.2% presented severe preeclampsia. The frequent clinical manifestations were lower limb edema and headache. 57.3% developed spontaneous labor, the pregnancy termination route was cesarean section in 57.3% of pregnant women. Regarding the product of conception, 69.1% had weight and height appropriate for gestational age, an APGAR of 8 at the first minute and of 9 at 5 minutes. In this study, a prevalence of 13.72% is reported with respect to hypertensive disorders of pregnancy. Particularly in patients older than 35 years, multiparous, with a body mass index ≥ 32 kg / m2, presenting a history of arterial hypertension, diabetes mellitus and pre-eclampsia.

Coronavirus 2019, thrombocytopenia and HELLP syndrome: association or coincidence? / Coronavírus 2019, trombocitopenia e síndrome HELLP: Associação ou coincidência?

Abstract The present report describes the case of a 31-year-old primigravida, with dichorionic twins at 31 weeks. She presented with history of myalgia, jaundice, and abdominal discomfort. No flu-like symptoms as fever or cough. She was not aware of exposure to COVID-19. Normal blood pressure and O2 saturation. Laboratory tests showed platelet count of 218,000 mm3, alanine aminotransferase (ALT) 558 IU and serum creatinine 2.3 mg/dl. Doppler ultrasound in one twin was compatible with brain sparing. Partial hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome was the hypothesis, and a cesarean section was performed. On day 2, the white-cell count reached 33,730, with decreased consciousness and mild respiratory distress. Tomography revealed both lungs with ground-glass opacities. Swab for COVID-19 polymerase chain reaction (PCR) was positive. Thrombocytopenia in patients with COVID-19 appears to be multifactorial, similar to what occurs in preeclampsia and HELLP syndrome. We assume that the synergism of these pathophysiological mechanisms could accelerate the compromise of maternal conditions and could be a warning to the obstetric practice.

Resumo O presente relato descreve o caso de uma gestante de 31 anos, gemelar dicoriônica com 31 semanas, com queixa de mialgia, icterícia e desconforto abdominal. A paciente não apresentava sintomas gripais como febre ou tosse e não tinha conhecimento de exposição ao COVID-19. Pressão arterial e saturação de oxigênio normais. Os exames laboratoriais apresentaram contagem de plaquetas de 218,000 mm3, ALT 558 IU e creatinina 2.3 mg/dl. Doppler compatível com centralização de um dos fetos. Síndrome de hemolysis, elevated liver enzymes, low platelet count (HELLP) parcial foi a hipótese diagnóstica inicial e a cesariana foi realizada. No segundo dia, a paciente apresentou leucócitos de 33.730 com queda do nível de consciência e desconforto respiratório leve. A tomografia revelou opacidade pulmonar em vidro fosco bilateralmente. A pesquisa de COVID-19 por polymerase chain reaction (PCR)/swab teve resultado positivo. Trombocitopenia em pacientes com COVID-19 é multifatorial, semelhante ao que ocorre na pré-eclâmpsia e na síndrome HELLP. Acreditamos que o sinergismo da fisiopatologia das doenças em questão pode acelerar o comprometimento materno e deve servir de alerta para a prática obstétrica.

Leucemia mieloide aguda y pre-eclampsia coexistente: algunas dificultades diagnósticas: a propósito de un caso / Acute myeloid leukemia and coexisting preeclampsia: some diagnosis difficulties: a case report

OBJETIVO: Remarcar la importancia de hacer un adecuado diagnóstico diferencial de la anemia y trombocitopenia en la gestante, ya que en ocasiones enmascaran cuadros tan graves como la leucemia. Presentar un caso de leucemia mieloide aguda con una preeclampsia sobreañadida y describir el proceso diagnóstico y terapéutico llevado a cabo. CASO CLÍNICO: Secundigesta, 25 años, gestante de 37 semanas, con antecedentes de preeclampsia, derivada desde atención primaria por alteración analítica y malestar general. A su llegada a urgencias el cuadro clínico es compatible con un Síndrome de HELLP. Tras el estudio del mismo se llega a la certeza de que se trata de una preeclampsia asociada a una leucemia mieloide aguda que ha simulado los parámetros analíticos de un Síndrome de HELLP. CONCLUSIONES: Es importante el adecuado estudio etiológico de la anemia y trombocitopenia en la gestación. La leucemia exige al clínico un abordaje precoz y multidisciplinar tanto diagnóstico como terapéutico.

OBJECTIVE: To emphasize on the importance of performing a precise differential diagnosis of anaemia and thrombocytopenia during pregnancy, as they can be due to important diseases as leukemia. A case of acute myeloid leukemia associated with preeclampsia is reported, describing the complexity of the diagnostic and therapeutic process. CLINICAL CASE: 25-year-old woman, gravida 2, para 1 (preeclampsia), at 36 weeks of gestation was referred to the emergency department by her primary care physician due to severe disturbance on the blood tests and general discomfort. Initially, a HELLP syndrome was suspected. However, after going in depth in the case, the final diagnosis was preeclampsia associated to acute myeloid leukemia, simulating blood parameters in HELLP syndrome. CONCLUSIONS: It is essential to study deeply and carry out a complete differential diagnosis process of anaemia and thrombocytopenia during pregnancy. Leukemia requires an early multidisciplinary management both for diagnosis and treatment.

Desenlaces materno-fetales de los embarazos con trastornos hipertensivos: un estudio transversal / Maternal and fetal outcomes of pregnancies with hypertensive disorders: a cross-sectional study

INTRODUCCIÓN Y OBJETIVO: Los trastornos hipertensivos asociados al embarazo son considerados un problema de salud pública. Se busca describir las características clínicas y desenlaces materno-fetales de las pacientes con esta patología, atendidas en el Hospital Universitario de Santander (HUS) durante el primer semestre de 2017. MÉTODOS: Estudio observacional retrospectivo de corte transversal. Se incluyeron las pacientes en estado de embarazo o puerperio con diagnóstico o sospecha de trastorno hipertensivo; se excluyeron aquellas que no pudieron ser clasificadas o no correspondían a éstos. RESULTADOS: Se analizaron 181 historias clínicas; la edad de las pacientes osciló entre 14 y 44 años; el 43,7% eran primigestantes; el 40,3% tuvo un control prenatal inadecuado y el 27,5% tenía antecedente de trastorno hipertensivo en gestaciones previas. El 75,1% de las pacientes fueron clasificadas como preeclampsia, 18,2% con hipertensión gestacional, 4,4% con hipertensión más preeclampsia sobreagregada y 2,2% con hipertensión crónica. El 16,9% de las pacientes con preeclampsia debutaron antes de la semana 34, de las cuales el 91,3% tenían criterios de severidad; mientras que entre las demás, el 84% presentaron criterios de severidad. CONCLUSIONES: La preeclampsia fue el trastorno hipertensivo más frecuente, predominó la presentación tardía y severa con importantes tasas de complicación maternas y fetales. Mediante la implementación de estrategias de detección temprana y adecuada atención de los trastornos hipertensivos asociados al embarazo podrían mejorarse los desenlaces materno-fetales.

BACKGROUND AND OBJECTIVE: Hypertensive disorders of pregnancy are considered a public health issue. The aim is to describe the clinical features, maternal - fetal outcomes of patients with this disease, who were admitted at the University Hospital of Santander (Bucaramanga, Colombia) during the first half of 2017. METHOD: Cross-sectional retrospective observational study. Patients in pregnancy or puerperium with diagnosis of hypertensive disorder were included; those who could not be classified or did not correspond were excluded. RESULTS: 181 clinical charts were analyzed, the age of the patients ranged between 14 and 44 years, 43.7% were nulliparous, 40.3% had an inadequate prenatal control and 27.5% had history of hypertensive disorder in previous pregnancies. 75.1% were classified as preeclampsia, 18.2% as gestational hypertension, 4.4% as hypertension and superimposed preeclampsia and 2.2% with chronic hypertension; 16.9% of the patients were of an early-onset preeclampsia before week 34, of which 91.3% had criteria of severity; among the others, 84% presented criteria of severity. CONCLUSION: Preeclampsia was the most frequent hypertensive disorder, late and severe presentation prevailed with important maternal and fetal complication rates. Through the implementation of early detection strategies and adequate care of hypertensive disorders associated with pregnancy maternal and fetal outcomes could be improved.

Hematoma subcapsular hepático roto en síndrome HELLP / Ruptured subscapular liver hematoma in context of HELLP syndrome

Background: Ruptured subscapular liver hematoma in context of HELLP syndrome is a rare complication with high mortality. Clinical presentation is nonspecific: epigastric pain, right upper quadrant pain and shoulder pain, should however provide high index of suspicion. Termination of pregnancy is the only definitive treatment with a beneficial effect on the mother and the fetus. According to the hemodynamic status of the patient, treatment can be conservative through hepatic artery embolization, or surgical management, via contained packing of the bleeding area. Aim: To report seven cases of ruptured subscapular liver hematomas treated in a period of 13 years. Material and Methods: Review of medical records of patients discharged with the diagnosis from 2002 to 2015. Results: We identified seven women aged 30 to 44 years, for a total of 86,858 live births. At presentation, mean gestational age was 36 weeks. Five patients reported epigastric pain and three shoulder pain. All patients met the criteria for HELPP syndrome. All patients were operated on, and packing of the bleeding zone was carried out in six. One patient died. Two newborns died. Conclusions: The features of these patients may help in the management of this uncommon but severe condition.

Hemolysis, Elevated Liver Enzymes, Low Platelets Syndrome Superimposed on Hemolytic Uremic Syndrome / Síndrome HELLP sobreposta a síndrome hemolítica-urêmica

Abstract A pregnancy complicated by typical hemolytic uremic syndrome (HUS) and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome is reported. At 20 weeks of gestation, a case of HUS was diagnosed, with Shiga toxin-producing Escherichia coli identified. Plasmapheresis allowed continuation of the pregnancy for 5 weeks. Superimposed preeclampsia and HELLP syndrome were diagnosed after the establishment of nephrotic range proteinuria, hypertension and recurrence of hemolysis. This is a singular case, as it demonstrates that HELLP syndrome can superimpose upon HUS, a fact that can impact future research on reproductive immunology. It also reminds clinicians that the overlapping of clinical and laboratory findings in HELLP syndrome makes the diagnosis of other thrombotic microangiopathies during pregnancy a clinical challenge.

Resumo Descreve-se um caso clínico em que às 20 semanas de gestação é diagnosticada síndrome hemolítica-urêmica com isolamento de Escherichia coli produtora de toxina Shiga. A terapêutica com plasmaferese permitiu a manutenção da gravidez ao longo de 5 semanas. O surgimento de proteinúria nefrótica, hipertensão e recorrência de hemólise conduziu ao diagnóstico de sobreposição de pré-eclâmpsia e síndrome HELLP. Este caso é singular, pois demonstra que a síndrome HELLP pode se sobrepor a uma síndrome hemolítica-urêmica, um fato que pode influenciar futuras investigações no âmbito de imunologia reprodutiva. Reforça-se, ainda, que o diagnóstico de outras microangiopatias trombóticas durante a gestação é um desafio clínico ocasionado pela sobreposição de manifestações clínicas e laboratoriais com a síndrome HELLP.

Morbimortalidad materna asociadas a preeclampsia en la Unidad de Cuidados Intensivos del HMIGU / Maternal mortality and morbidity associated with preeclampsia in the Intensive Care Unit HMIGU

OBJETIVO: describir las principales causas de morbilidad y mortalidad materna por preeclampsia en la Unidad de Cuidados Intensivos Maternos (UCIM) del Hospital Materno Infantil Germán Urquidi (HMIGU). MÉTODOS: un total de 47 pacientes con diagnóstico de Preeclampsia que ingresaron a Cuidados Intensivos Maternos del Hospital Materno Infantil German Urquidi fueron registrados de Enero a Diciembre de 2015, a quienes se realizó un estudio observacional y prospectivo. La morbimortalidad es evaluada y descrita. RESULTADOS: la preeclampsia y sus complicaciones constituyen las principales causas de ingreso a Cuidados Intensivos Maternos del Hospital Materno Infantil German Urquidi con un 44%. La distribución diagnóstica de las principales complicaciones fue: HELLP (57%), eclampsia (48%), lesión renal aguda (19%), CID (8,5%), ACV (6,38%) y edema agudo pulmonar (2,1%) (Tabla 2). La mortalidad materna asociada a esta patología fue de 6,38 % (1 paciente con eclampsia, 1 paciente con edema agudo pulmonar y 1 paciente con CID) (Figura 2). La estancia media en la UCIM fue de 3,55 2,17 días (Tabla 3). CONCLUSIONES: la primigestación sigue siendo un factor prevalente (48%), tal y como se ha descrito en otros trabajos. La preeclampsia de inicio precoz (menor a 34 semanas) es predominantemente relevante dentro la historia natural de la enfermedad con un 51,4%. Las principales complicaciones y su prevalencia se aproximan a los descritos por Malvino 2012 y Briones 2013. La vigilancia y monitorización de estas pacientes en Cuidados Intensivos puede detectar de forma precoz la aparición de complicaciones con un beneficio secundario sobre la morbimortalidad. Por el bajo número de pacientes tomadas como muestra, no se pueden extraer conclusiones válidas referentes a la mortalidad.

OBJECTIVE: to describe the main causes of maternal morbidity and mortality due to preeclampsia in the Maternal Intensive Care Unit (UCIM) of the Hospital Materno Infantil Germán Urquidi (HMIGU). METHOD: a total of 47 patients diagnosed with Preeclampsia admitted to the Intensive Care Maternal and Child Hospital German Urquidi Maternal were recorded from January to December of 2 015, to whom a prospective observational study was conducted. Morbidity and mortality is assessed and described. RESULTS: eclampsia and its complications are the leading causes of admission to Intensive Care Maternal and Child Hospital German Urquidi Maternal and 44%. The diagnostic distribution of major complications was: HELLP (57%), eclampsia (48%), acute kidney injury (19%), CID (8, 5 %), stroke (6,38%) and acute pulmonary edema (2,1%) (Table 2). Maternal mortality associated with this disease was 6,38 % (1 patient with eclampsia, 1 patient with acute pulmonary edema and 1 patient with DIC) (Figure 2). The average length of stay in the MICU was 3,55 2,17 days (Table 3). CONCLUSIONS: the primigestación remains a prevalent factor (48%), as described in other works. Early-onset preeclampsia (less than 34 weeks) is predominantly relevant in the natural history of disease with 51,4%. The main complications and its prevalence approach described by Malvino 2012 and 2013 Briones surveillance and monitoring of these patients in intensive care can detect early onset of complications with a secondary benefit on morbidity and mortality. For the low number of patients taken as a sample, no valid conclusions can be drawn concerning mortality.

Hallazgos clínicos y de laboratorio que sugieren tempranamente el síndrome de HELLP en pacientes con preeclampsia severa / Clinical and laboratory findings suggest that early HELLP syndrome in patients with severe preeclampsia

Objetivo: Determinar la utilidad de las pruebas de laboratorio y clínicas que se alteran de forma precoz para el diagnóstico del síndrome de HELLP en pacientes con preeclampsia severa. Métodos: Estudio observacional retrospectivo, de utilidad de prueba diagnóstica, basado en una cohorte clínica que incluyó mujeres embarazadas con diagnóstico de preeclampsia severa ingresadas entre el 4 de mayo del 2005 al 7 mayo del 2008 en la Clínica Universitaria Bolivariana (CUB). Se realizó comparación entre los dos grupos (HELLP y no HELLP) en las variables estudiadas. Se calculo la sensibilidad, la especificidad, los valores predictivos y las LR (+ y -), y sus IC al 95 por ciento, comparando cada una de las variables clínicas, con la prueba oro: diagnóstico final de HELLP. Se realizaron curvas ROC para las pruebas cuantitativas en la hospitalización para identificar cual es el parámetro de laboratorio que mejor determina el desarrollo del síndrome de HELLP. Resultados: El dolor en epigastrio fue el factor clínico predictor más importante en los pacientes con pre eclampsia severa que desarrollaron HELLP con un valor de p<0,0001; de las pruebas de laboratorio realizadas al ingreso, las transaminasas fueron significativamente mayores en las pacientes con preclampsia severa que desarrollaron síndrome de HELLP. Conclusión: En las pacientes con diagnóstico de preeclampsia severa la presencia de epigastralgia y/o transaminasas elevadas son hallazgos que sugieren tempranamente el desarrollo de síndrome de HELLP.

Objectives: The aim of this study was to determine the usefulness of precociously altered clinical and laboratory tests for the diagnosis of HELLP in patients with severe preeclampsia. Methods: An observational study was performed, utility of diagnostic tests, based on a clinical cohort which included pregnant women diagnosed with severe preeclampsia admitted between May 4, 2005 and May 7, 2008 in the Clinica Universitaria Bolivariana was conducted. Comparison was made between the two groups (HELLP and non HELLP) on the assessed variables. Sensitivity, specificity, predictive values and the LR (+ and -) and their 95 percent CI were calculated, comparing each of the clinical variables with the golden standard test: final diagnosis of HELLP. ROC curves were performed for the laboratory quantitative tests during hospitalization to identify which is the laboratory parameter that best determines the development of HELLP syndrome. Results: Epigastrium pain was the most important predictive factor in clinical patients with severe preeclampsia who developed HELLP with a value of p<0.0001. The values of laboratory tests and transaminases conducted at admission were significantly higher in patients with severe preeclampsia who developed HELLP syndrome. Conclusion: This study found that in patients diagnosed with severe preeclampsia, the presence of epigastric pain and / or transaminases are findings suggest the early development of HELLP syndrome, for that reason changes of liver tests and the presence of epigastric pain should be actively tracked in this group of patients.

Síndrome de HELLP normotensivo: caso clínico / Normotensive HELLP syndrome: Report of one case

HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) represents a severe form ofpreeclampsia associated with serious maternal and fetal morbiditiesand even death. Usually HELLP syndrome appears during the evolution of a severepreeclampsia; however HELLP syndrome can have atypical clinical manifestations.We report a 22-year-old female who consulted at 20 weeks of pregnancy for lumbarpain, dysuria and fever. A urinalysis revealed the presence of white blood cells. Thepatient was admitted to hospital and treated with antimicrobials. Forty eight hoursafter admission a proteinuria of 440 mg/24 h was detected. A severe pre eclampsia-HELLP syndrome was diagnosed. However the patient remained with normal bloodpressure. An elevation of liver enzymes and creatinine were observed. Five dayslater fetal death was confirmed and an abortion was induced. The patient requireda platelet transfusion. Four days after the abortion, the patient was discharged ingood conditions.

Hígado graso agudo del embarazo y síndrome HELLP: aspectos diagnósticos y terapéuticos / Acute fatty liver of pregnancy and HELLP syndrome: diagnostic and therapeutic aspects

HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) and acute fatty liver of pregnancy (AFLP), cause liver dysfunction in the third trimester of pregnancy and determine risk of maternal and fetal mortality. Many maternal complications can occur, including acute renal failure and coagulopathy. Early diagnosis, prompt delivery and adequate supportive care are the key to a good outcome in most of the patients. In some cases, despite an appropriate conventional management, the disease may progress to multiple organ dysfunction, progressive liver insufficiency or severe hepatic complications (subcapsular hematoma, liver rupture), requiring adjunctive medical therapy, such as plasma exchange, surgery or liver transplantation.

El síndrome HELLP (hemolysis, elevated liver enzymes, and low platelet count) y el hígado graso agudo del embarazo (acute fatty liver of pregnancy -AFLP), son causa de disfunción hepática en el tercer trimestre del embarazo y condicionan riesgo de mortalidad materna fetal. Se pueden presentar diversas complicaciones como insuficiencia renal aguda y coagulopatía, entre otras. El diagnóstico oportuno, la interrupción del embarazo y un manejo de sostén adecuado permiten sacar adelante a la mayoría de las pacientes. En algunos casos, a pesar de un manejo convencional adecuado, la enfermedad puede evolucionar con disfunción multiorgánica, insuficiencia hepática progresiva o complicaciones hepáticas graves (hematoma subcapsular, rotura hepática), requiriendo de terapia médica adyuvante, como la plasmaféresis, cirugía o incluso trasplante hepático.

Síndrome de Evans de aparición súbita en el embarazo / Evans syndrome of sudden onset in pregnancy

La trombocitopenia complica hasta el 10 por ciento de los embarazos. El síndrome de Evans es la coexistencia de la trombocitopenia inmune con anemia hemolítica autoinmune. Se presenta un caso de síndrome de Evans durante el embarazo, complicado por preclampsia y neutropenia fetal. Una mujer de 20 años de edad, previamente sana, primigesta, que presentó a las 34 semanas de gestación dolor epigástrico, trombocitopenia y pre eclampsia. Se le realizó parto por cesárea, por presentar síndrome de HELLP. A los 25 días de postparto, reingresó al Hospital con trombicitopenia severa, plaquetas 2000 x mm3 , anemia hemoglobina 5,3g/dl y fiebre. El Coombs directo fue positivo y el análisis posterior demostró la presencia de anticuerpos anti-plaquetarios, y anticardiolipina. Recibió transfusiones de sangre y plaquetas. Se le trató con prednisona, plasmaferesis, azatioprima y finalmente, resolvió su cuadro clínico después de 10 días de internamiento en una unidad de cuidado intensivo.

Management of HELLP syndrome

We present here successful management of a patient of severe HELLP syndrome, secondary to retained products of conception [POC's]. The management of our patient started just after her presentation in the emergency department of our hospital. Clinical history of post-partum bleeding, fits and confusion, along with deranged laboratory investigations lead us to an aggressive management plan, conducted by a team of healthcare professionals and the patient was saved

Diagnóstico e conduta na Síndrome HELLP / Diagnosis and management of HELLP Syndrome

A síndrome HELLP é definida classicamente pela presença de hemólise, elevação das enzimas hepáticas e plaquetopenia durante a gravidez. Acredita-se que essa síndrome seja uma variante da pré-eclâmpsia grave, apesar de nem sempre ocorrer hipertensão arterial. A síndrome HELLP ocorre em cerca de 1 a 2 casos a cada 1.000 gestações, e sua importância reside na elevada morbimortalidade materna e fetal. Dessa forma, o diagnóstico oportuno poderá livrar a mãe e o feto dos efeitos deletérios da doença. O tratamento definitivo consiste no parto, entretanto, a conduta dependerá da idade gestacional, da vitalidade fetal e das condições clínicas maternas. Neste artigo revisam-se os principais indícios diagnósticos da síndrome HELLP, bem como as condutas para o melhor benefício materno-fetal.

HELLP syndrome is classically defined by the presence of hemolysis, elevated liver enzymes and low platelets (thrombocytopenia), during pregnancy. It is considered a variant of severe pre-eclampsia, although hypertension might not always occur. HELLP syndrome occurs in approximately 1 to 2 cases per 1000 pregnancies, and its importance is related to the high maternal and fetal mortality. Thus the diagnosis should be able to deliver mother and fetus from the deleterious effects of the disease. The definitive treatment is the delivery, however HELLP prognosis will depend on the fast diagnosis, and the treatment must take into consideration the gestational age, the fetal and the maternal medical conditions. This review article focus on HELLP syndrome major evidences as well as on the best maternal-fetal benefitial behavior.

Síndrome HELLP: relato de caso / HELLP syndrome: case report

Este artigo relata o caso de paciente de 20 anos de idade, feoderma, grávida de 35 semanas e três dias, primigesta, com síndrome HELLP. Foi internada na Maternidade do Hospital das Clínicas da UFMG após apresentar lombalgia e vômitos. Foram constatadas hipertensão e proteinúria. Submeteu-se à propedêutica para síndrome HELLP, que revelou plaquetopenia, elevação de transaminases e de desidrogenase lática. A gestante foi submetida a cesariana segmentar sob anestesia geral. Evoluiu com hipotonia uterina e hemorragia puerperal. Recebeu concentrado de plaquetas e de hemácias. Teve alta após cinco dias, com exames laboratoriais normais.

This is the case report a 20-year-old pregnant woman, yellow-skinned (feoderma), with gestational age 35 weeks and 3 days, primigravida with a final diagnosis of HELLP syndrome. She was admitted at the Maternity section of Hospital das Clínicas da UFMG, after presenting symptoms of low back pain, abdominal pain and vomiting. The physical examination and tests found hypertension and proteinuria. The laboratory tests for HELLP syndrome revealed thrombocytopenia, elevated transaminases and lactate dehydrogenase (LDH). The patient underwent a caesarean section under general anesthesia. She presented hypotonic uterine inertia and postpartum hemorrhage. The patient was given platelet concentrates and red blood cells. She was discharged after the 5th day, with normal laboratory.