ABSTRACT
OBJECTIVE: Authors in the article describe a case of a patient with thrombotic thrombocytopenic purpurain 37 weeks gestation complicated by acute severe hemorrhagic-necrotic pancreatitis during the early puerperium. DESIGN: Case report. SETTING: Ist Department of gynaecology and obstetrics of the Comenius University Bratislava. CASE-REPORT: 33-years-old patient in the 37 weeks gestation was admitted to our department with the signs of HELLP syndrome (hemolysis, elevated liver enzymes, low platelets). Due to the worsening clinical status, we have performed caesarean section. After the transient stabilization of the patient's clinical status, the hemolysis with severe thrombocytopenia reappeared. Based on the clinical signs of abdominal pain and computer tomography, the diagnosis of acute hemorrhagic-necrotic pancreatitis was set. The primary diagnosis was thrombotic thrombocytopenic purpura. Therefore, therapeutic plasma exchange was performed with consequent improvement of the patients clinical state. Normalization of the platelet count was achieved after 4.plasma exchanges. Consequently 5 plasma exchanges were performed. However, one month later, the disease relapsed. Therapeutic plasma exchanges were needed again (4x), with anti CD 20 administration. This therapy had good clinical outcome, without the need for further plasma exchanges. CONCLUSION: Thrombotic thrombocytopenic purpura is highly lethal disease. Early diagnosis, treatment, and multidisciplinary approach are essential.
Subject(s)
Early Diagnosis , Pancreatitis, Acute Necrotizing/etiology , Plasma Exchange/methods , Postpartum Period , Pregnancy Complications, Hematologic , Purpura, Thrombotic Thrombocytopenic/complications , Adult , Female , Gestational Age , Humans , Pancreatitis, Acute Necrotizing/diagnosis , Pancreatitis, Acute Necrotizing/therapy , Pregnancy , Purpura, Thrombotic Thrombocytopenic/diagnosis , Purpura, Thrombotic Thrombocytopenic/therapy , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: Analysis of perinatological outcome in Slovak Republic in the years 2007-2009. DESIGN: Epidemiological perinatological nation-wide. SETTINGS: 1st Department of Gynaecology and Obstetrics School of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic. METHODS: Retrospective analysis of some perinatological data from the years 2007-2009 available in database of expert for gynaecology and obstetrics Ministry of Health Slovak Republic. RESULTS: The number of maternity hospitals decreased from 63 to 57 in the years 2007-2009. Total number of deliveries increased from 51,146 to 56,094 and that of live births from 51,650 to 56,579 in this period. Perinatal mortality rate was 6.2, 6.6 and 6.0 per 1000 in the years 2007, 2008 and 2009 respectively. Caesarean section rate progressively increased from 24.1% to 27.4% in this period. Preterm deliveries rate ranged between 7.3% and 7.5% and that of multiple pregnancies 1.3% and 1.4%. Maternal mortality ratio increased from 8 to 25 per 100,000 live births. CONCLUSION: Perinatal mortality rate 6.0 per thousand is the best result of Slovak perinatological history. Caesarean rate frequency rapidly increased up to 27.4% in the year 2009. Centralisation of high-risk pregnancies, transfer "in utero" and prenatal detection of congenital malformations are still to be improved in Slovakia.
