A case of severe preeclampsia diagnosed as post-partum hemolytic uremic syndrome / 中华医学杂志(英文版)

Post-partum hemolytic uremic syndrome (PHUS) is a severe thrombotic microangiopathy clinically characterized by hemolytic anemia, renal dysfunction, and low platelets after birth with rapid progression and poor prognosis. Here, we reported a rare case of severe preeclampsia diagnosed as hemolytic uremic syndrome after birth. The patient was diagnosed with PHUS and underwent intermittent plasma exchange with supportive treatment including glucocorticoid injections and transfusion of suspended red blood cells. After these treatments, the patient experienced no apparent remission and chronic renal dysfunction occurred on her. PHUS is a severe emergency with acute onset, rapid progress, and poor prognosis. Early detection, diagnosis, and treatment can significantly improve the prognosis.

Patient with antiphospholipid syndrome accompanied by pre-eclampsia who developed hellp syndrome and eclampsia after abortion / 中华医学杂志(英文版)

Antiphospholipid syndrome (APS) refers to a group of clinical symptoms and signs caused by antiphospholipid antibody (aPLA). We reported a rare case of poor outcome of a pregnant woman with APS. The pregnant woman had APS, hemolytic anemia, elevated liver function and low platelet count (HELLP) syndrome, and eclampsia and had a poor outcome from a second pregnancy. She was treated with antispasmodics, sedatives, and anti-hypertensive agents, along with anticoagulant therapy and infusion of immunoglobulin. APS during pregnancy often makes pregnancy even more complex and risky. Obstetricians should carry out anticoagulation treatment throughout the perinatal period.

A case of aggravation of hemolytic anemia, elevated liver enzymes and low platelet count syndrome after delivery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hemolytic anemia, elevated liver enzymes and low platelet count (HELLP) syndrome is a severe obstetric complication which usually resolves in most patients after delivery.</p><p><b>METHODS</b>We report a rare case of aggravation of HELLP syndrome after delivery.</p><p><b>RESULTS</b>The patient underwent the treatment for HELLP syndrome, including glucocorticoid therapy. The symptoms of HELLP syndrome reappeared and became more severe than before the termination of pregnancy. The patient also had severe and persistent hypoproteinemia, hyponatremia and hypocalcemia.</p><p><b>CONCLUSIONS</b>HELLP syndrome is an acute and critical obstetric syndrome which can have heterogeneous presentations and variable prognosis. We should be fully aware of the diverse clinical characteristics of this condition.</p>

Investigation of diagnosis and treatment of hemolysis-elevated liver enzymes-low platelet counts (HELLP) syndrome: clinical analysis of 59 cases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hemolysis-elevated liver enzymes-low platelet counts (HELLP) syndrome is a clinical condition occurring in middle and late stage pregnancy. It is characterized by hemolysis, elevated liver enzymes and low platelet counts. This study involves the analysis of the diagnosis, clinical characteristics and treatment of 59 cases of HELLP syndrome as well as the clinical classification, method of delivery and gestational age at delivery.</p><p><b>METHODS</b>Clinical data from 59 cases of HELLP syndrome occurring from January 2000 to December 2009 were analyzed retrospectively. Thirty-five cases were classified as complete HELLP syndrome and 24 cases were considered partial HELLP syndrome.</p><p><b>RESULTS</b>Twenty-six of the 59 analyzed patients (44%) with complete HELLP syndrome showed rapid onset, severe signs, symptoms, and complications in addition to a poor clinical outcome. Complications included multiple organ dysfunction syndrome (MODS) occurring in 18 cases, eclampsia (3 cases), placental abruption (3 cases), and perinatal death (4 cases). The remaining 33 cases (24 with partial and 9 with complete HELLP) were characterized by less severe signs, symptoms, complications and progression of the condition. Two of these cases were complicated with MODS (6.1%), and 1 with perinatal death (3.0%). Twelve non-radical-type cases received conservative treatment. The remaining 4 patients had recurring HELLP syndrome (6.78%).</p><p><b>CONCLUSIONS</b>HELLP syndrome is classified as the radical type and non-radical-type according to clinical characteristics and outcome. Classification of HELLP syndrome cases according to clinical features can help in the monitoring and treatment of the disease. Active termination of pregnancy should be considered for radical-type cases. Non-radical-type cases can undergo conservative treatment with close monitoring in an attempt to improve perinatal outcome without increasing maternal morbidity.</p>

Diagnosis of appendicitis during pregnancy and perinatal outcome in the late pregnancy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Appendicitis is the most common surgical problem in pregnancy, however the particular dangers of appendicitis in pregnancy lie in the varied presentation of symptoms and the higher chance of delayed diagnosis. The aim of this study was to determine the risk factors associated with prenatal outcome in acute appendicitis during second and third trimester pregnancies.</p><p><b>METHODS</b>This was a retrospective single-center study that presented a descriptive analysis of the results. A total of 102 pregnant women who were diagnosed with acute appendicitis and operated upon in Peking University Third Hospital, China between January 1993 and December 2007 were presented. SPSS 12.0 for Windows was used for data analysis.</p><p><b>RESULTS</b>Seventy-eight pregnant women who were diagnosed with acute appendicitis (sixteen patients had a perforated appendix, 62 patients had a non-perforated appendix) were operated upon during late pregnancy. The interval between symptom onset and surgery was the only predictive variable. A longer interval between symptom onset and surgery was associated with appendix perforation ((109.5 +/- 52.7) hours) than with no appendix perforation ((35.1 +/- 19.62) hours; P = 0.007). There was a significant difference in the rate of preterm labor (5.1% vs 1.3%) and the rate of fetal mortality (25% vs 1.7%) between patients with and without a perforated appendix.</p><p><b>CONCLUSIONS</b>Delaying surgery correlates to more advanced disease with an increased risk of perforation. This contributes to an increased risk of further complications, including premature labor or abortion, and to higher maternal complication rates. Prompt diagnosis may improve the prenatal outcome.</p>