RESUMO
PURPOSE OF INVESTIGATION: The purpose of this study was to evaluate the maternal and perinatal outcome and prognosis in pregnant women with HELLP syndrome. MATERIALS AND METHODS: Medical records of eligible pregnant women with HELLP syndrome were reviewed retrospectively. Patients were evaluated in terms of maternal complication, as well as the types of delivery. Perinatal outcome were evaluated in terms ofApgar score, birth weight, respiratory distress syndrome, and neonatal intensive care unit admission. RESULTS: The leading maternal complications associated with HELLP syndrome were the following: severe preeclampsia, eclampsia, placental abruption, acute pulmonary edema, acute kidney failure, disseminated intravascular coagulation syndrome, and immediate maternal death. The most prominent neonatal outcomes associated with HELLP syndrome were: antenatal fetal death, intrauterine growth restriction, prematurity. CONCLUSION: The management and delivery of the patients with HELLP syndrome must take place in a tertiary referral maternal and fetal care centre.
Assuntos
Coagulação Intravascular Disseminada/epidemiologia , Morte Fetal , Retardo do Crescimento Fetal/epidemiologia , Síndrome HELLP/mortalidade , Morte Materna , Nascimento Prematuro/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Descolamento Prematuro da Placenta/epidemiologia , Adulto , Peso ao Nascer , Eclampsia/epidemiologia , Feminino , Feto , Síndrome HELLP/epidemiologia , Humanos , Recém-Nascido , Masculino , Pré-Eclâmpsia/epidemiologia , Gravidez , Resultado da Gravidez , Prognóstico , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto JovemRESUMO
The authors present the case of a postpartum splenic rupture induced probably by iatrogenic injury (recent vaginal delivery with a prolonged expulsion with uterine fundus compression) including the left hypochondria region costal grid. The case was solved with splenic preservation and achieving hemostasis only by local plugging and Gelaspon. The case raised also other problems regarding the etiology of splenic rupture, in establishing a causal relationship between a intrapartum splenic injury, and the three episodes of inferior genital tract hemorrhaging, in establishing the cause of the infectious syndrome from the 24h postpartum day, (parietal infection or splenic abscess requiring splenectomy).
Assuntos
Complicações do Trabalho de Parto/terapia , Transtornos Puerperais/etiologia , Transtornos Puerperais/terapia , Ruptura Esplênica/etiologia , Ruptura Esplênica/terapia , Adulto , Feminino , Humanos , Doença Iatrogênica , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/etiologia , Gravidez , Transtornos Puerperais/diagnóstico , Esplenectomia , Ruptura Esplênica/diagnósticoRESUMO
Two cases of nuchal fold abnormalities diagnosed by transvaginal ultrasonography are presented: nuchal edema at 10 weeks (fold = 5.5 mm) of normal size at 13 weeks (fold = 2.6 mm) and cystic hygroma colli associated with omphalocel in a women with a 24-week arrested pregnancy terminated by spontaneous abortion. Genetic tests done in the second case showed a karyotype 45XO. The etiopathogenesis of nuchal skin fold abnormalities--edema and cystic hygroma colli is discussed. The importance of ultrasound screening during pregnancy is emphasized, the detection rate of genetic abnormalities depending on both the quality of the ultrasound equipment and examiners skills. Ultrasound examination at 10 and 20 weeks--ultrasound marker (nuchal fold, LF ratio and DBP/FL ratio)--together with the triple test (AFP, HCG and E3) in the mathematical model used for detecting the risk of genetic defects may represent an alternative to amniocentesis and trophoblast biopsy when this is impracticable or rejected by the patient.
