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
Over the last two to three decades, there has been a 15-25 % increase in many countries in the number of women giving birth to large infant. Fetal macrosomia is associated with an increased risk of complications both for the mother and the newborn. In current obstetrics, the macrosomic fetus represents a frequent clinical challenge. The early detection and identification of the risks associated with fetal macrosomia is important to managing the pregnancies and at last the timing and mode of delivery. This article provides possibilities of ultrasound diagnosis throughout the pregnancy and investigates the effectiveness of fetal measurements in identifying the large fetus (Tab. 1, Ref. 24).
