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1. HELLP syndrome

HELLP syndrome HELLP syndrome - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  HELLP syndrome Last reviewed: February 2019 Last updated: January 2019 Summary Considered to be a severe form of pre-eclampsia (sometimes called 'atypical pre-eclampsia') characterised by haemolysis (H), also expressed as microangiopathic haemolytic anaemia, elevated liver enzymes (EL), and low platelets (LP). Usually occurs antepartum (...) patient (usually within 7 days of delivery). An affected patient often displays hypertension and proteinuria (80% to 85%), epigastric/right upper quadrant (RUQ) pain (40% to 100%), nausea, vomiting, headache, and malaise. Some patients may present without these signs/symptoms when first evaluated for unexplained thrombocytopenia. The diagnosis of HELLP syndrome should be considered in any pregnant patient presenting in the second half of gestation or immediately postpartum with significant new-onset

2019 BMJ Best Practice

3. HELLP syndrome

HELLP syndrome HELLP syndrome - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  HELLP syndrome Last reviewed: February 2019 Last updated: January 2019 Summary Considered to be a severe form of pre-eclampsia (sometimes called 'atypical pre-eclampsia') characterised by haemolysis (H), also expressed as microangiopathic haemolytic anaemia, elevated liver enzymes (EL), and low platelets (LP). Usually occurs antepartum (...) patient (usually within 7 days of delivery). An affected patient often displays hypertension and proteinuria (80% to 85%), epigastric/right upper quadrant (RUQ) pain (40% to 100%), nausea, vomiting, headache, and malaise. Some patients may present without these signs/symptoms when first evaluated for unexplained thrombocytopenia. The diagnosis of HELLP syndrome should be considered in any pregnant patient presenting in the second half of gestation or immediately postpartum with significant new-onset

2018 BMJ Best Practice

4. Severe reduction of free-form ADAMTS13, unbound to von Willebrand factor, in plasma of patients with HELLP syndrome (PubMed)

Severe reduction of free-form ADAMTS13, unbound to von Willebrand factor, in plasma of patients with HELLP syndrome Severely decreased ADAMTS13 unbound to VWF may play a key role in the pathogenesis of HELLP syndrome.A qualitative ADAMTS13 assay may be important for diagnosing HELLP syndrome.

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2017 Blood advances

5. Hepatic rupture in preeclampsia and HELLP Syndrome: review of a catastrophic presentation

Hepatic rupture in preeclampsia and HELLP Syndrome: review of a catastrophic presentation Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites

2019 PROSPERO

6. Increased placental expression of Placental Protein 5 (PP5) / Tissue Factor Pathway Inhibitor-2 (TFPI-2) in women with preeclampsia and HELLP syndrome: Relevance to impaired trophoblast invasion? (PubMed)

Increased placental expression of Placental Protein 5 (PP5) / Tissue Factor Pathway Inhibitor-2 (TFPI-2) in women with preeclampsia and HELLP syndrome: Relevance to impaired trophoblast invasion? Placental Protein 5 (PP5)/Tissue Factor Pathway Inhibitor-2 (TFPI-2) is an extracellular matrix-associated protein mainly expressed by the syncytiotrophoblast that may regulate trophoblast invasion. Our aim was to study placental PP5/TFPI-2 expression and its relation to placental pathology in various (...) forms of preeclampsia and HELLP syndrome.Placental and maternal blood specimens were collected at the time of delivery from the same women in the following groups: 1) early controls; 2) early preeclampsia; 3) early preeclampsia with HELLP syndrome; 4) late controls; and 5) late preeclampsia. After histopathological examination, placental specimens were immunostained with polyclonal anti-PP5/TFPI-2 antibody on Western blot and tissue microarray immunohistochemistry. Placental PP5/TFPI-2 immunoscores

2019 Placenta

7. Aspartate-aminotransferase to platelet ratio index score for predicting HELLP syndrome. (PubMed)

Aspartate-aminotransferase to platelet ratio index score for predicting HELLP syndrome. HELLP (hemolysis, elevated liver enzyme levels, low platelet counts)-syndrome is a rare but dramatic pregnancy-related illness. The difficult part of this syndrome is the lack of standardised diagnostic criterias and tests to be used to predict it. The aim of this study is determining the role of APRI score in the diagnosis of HELLP syndrome.In this cross sectional, retrospective study, patients with HELLP (...) syndrome as case group and age-matched healthy pregnants at the similar pregnancy trimester as control group were included between January 12,017 and May 31, 2018. Data including sex, age, laboratory values, prognosis were recorded from the computerized system of the hospital. The p-value <0.05 was considered statistically significant.40 patients with HELLP syndrome and 124 age-matched healthy pregnants included in the study. There was a statistically significant difference between control group

2019 American Journal of Emergency Medicine

8. Proteasome Levels and Activity in Pregnancies Complicated by Severe Preeclampsia and Hemolysis, Elevated Liver Enzymes, and Thrombocytopenia (HELLP) Syndrome. (PubMed)

Proteasome Levels and Activity in Pregnancies Complicated by Severe Preeclampsia and Hemolysis, Elevated Liver Enzymes, and Thrombocytopenia (HELLP) Syndrome. Excessive accumulation of misfolded proteins was recently demonstrated in preeclampsia. We examined levels and activity of circulatory proteasome and immunoproteasome (inflammatory subtype) in preeclampsia and hemolysis, elevated liver enzymes, and thrombocytopenia (HELLP) syndrome. We analyzed samples from women with hypertensive (...) pregnancy disorders (n=115), including preeclampsia with severe features (sPE) and HELLP syndrome, and normotensive controls (n=45). Plasma proteasome and immunoproteasome immunoreactivity were determined by quantifying the α-subunit of the 20S core and β5i (proteasome subunit beta 8 [PSMB8]), respectively. Plasma proteasome activity was analyzed with fluorogenic substrates. MG132, lactacystin, and ONX0914 were used to inhibit the circulating proteasome and immunoproteasome, respectively. Plasma

2019 Hypertension

9. HELLP syndrome in a pregnant patient with Gitelman syndrome (PubMed)

HELLP syndrome in a pregnant patient with Gitelman syndrome Gitelman syndrome is characterized by hypokalemia, metabolic alkalosis, hypocalciuria, and hypomagnesemia. The clinical course of Gitelman syndrome in pregnant women remains unclear, but it is thought to be benign. We report here the first Korean case of atypical eclampsia in a 31-year-old who was diagnosed with Gitelman syndrome incidentally during an antenatal screening test. The patient did well during pregnancy despite significant (...) hypokalemia. At 33 weeks' gestation, the patient exhibited eclampsia, hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, and renal insufficiency without significant hypertension or proteinuria. We explain this unusual clinical course through a review of the relevant literature.

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2017 Kidney research and clinical practice

10. Importance of correctly interpreting magnetic resonance imaging to diagnose posterior reversible encephalopathy syndrome associated with HELLP syndrome: a case report (PubMed)

Importance of correctly interpreting magnetic resonance imaging to diagnose posterior reversible encephalopathy syndrome associated with HELLP syndrome: a case report Severe haemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome in pregnancy are possible underlying trigger factors for posterior reversible encephalopathy syndrome (PRES). Magnetic resonance imaging (MRI) shows diffuse signal abnormalities involving the subcortical white matter in the parieto-occipital (...) lobes. Although the diagnosis of RPES was clearly established by the distinctive reversibility of clinical and radiological abnormalities, it is difficult to distinguish from differential diagnosis. Thus, it is important to correctly interpret MRI.We describe a case of HELLP syndrome with PRES. A 38-year-old pregnant woman was admitted to our hospital as an emergency case with a complaint of upper abdominal pain and headache at 29 weeks of pregnancy and the development of HELLP syndrome

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2017 BMC Medical Imaging

11. Incidence, characteristics, maternal complications, and perinatal outcomes associated with preeclampsia with severe features and HELLP syndrome (PubMed)

Incidence, characteristics, maternal complications, and perinatal outcomes associated with preeclampsia with severe features and HELLP syndrome To determine the incidence of preeclampsia with severe features among pregnant women and evaluate the characteristics, maternal complications, and perinatal outcomes between nonsevere preeclampsia versus preeclampsia with severe features and hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome.A retrospective descriptive (...) period, out of which 213 preeclamptic women were identified. One hundred and seven women (9.6 per 1,000 deliveries) were diagnosed with nonsevere preeclampsia, 90 (8 per 1,000 deliveries) had preeclampsia with severe features, and 16 (1.4 per 1,000 deliveries) had HELLP syndrome. Twenty-one women (9.9%) experienced postpartum hemorrhage; 11 (10.3%) in the nonsevere features preeclampsia group and 10 (9.4%) in the preeclampsia with severe features and HELLP syndrome group. Placental abruption (3 women

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2018 International journal of women's health

12. Hepatic infarction induced by HELLP syndrome: a case report and review of the literature. (PubMed)

Hepatic infarction induced by HELLP syndrome: a case report and review of the literature. HELLP syndrome is a rare disease in China, and 20% of patients with severe preeclampsia have been accompanied with HELLP syndrome, which is characterized by the presence of hemolysis, elevated liver enzymes and low platelet count.In this case, we reported that a patient with preeclampsia was diagnosed with HELLP syndrome. Furthermore, hepatic infarction also was found via the computed tomographic (CT (...) was helpful to identify the rare complication of HELLP syndrome. Thus, we diagnosed a patient with HELLP syndrome with hepatic infarction, though the patient had no chance to do the liver biopsy.

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2018 BMC Pregnancy and Childbirth

13. HELLP syndrome, risk factors in first and second pregnancy: a population-based cohort study. (PubMed)

HELLP syndrome, risk factors in first and second pregnancy: a population-based cohort study. HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) may have specific risk factors and risk factors varying from first to second pregnancy. The aims of the study were to estimate the risk of HELLP syndrome by potential risk factors in first and second pregnancy, respectively.A population-based cohort study including all women in Norway having their first baby (≥22 gestational (...) weeks) during 1999 to 2014, registered in the Medical Birth Registry (n = 418 897). A subset of women with at least two births (n = 249 070) was used for estimates in second pregnancy. Relative risks with 95% CIs for HELLP syndrome were estimated using logistic regression and adjusted for maternal age and year of childbirth.Body mass index ≥30 kg/m2 and diabetes were associated with HELLP syndrome in first, but not in second pregnancy. Chronic hypertension and multiple pregnancy were associated

2018 Acta Obstetricia et Gynecologica Scandinavica

14. Role and mechanism of AT1-AA in the pathogenesis of HELLP syndrome (PubMed)

Role and mechanism of AT1-AA in the pathogenesis of HELLP syndrome HELLP syndrome remains a leading cause of maternal and neonatal mortality and morbidity worldwide, which symptoms include hemolysis, elevated liver enzymes and low platelet count. The objective of this study was to determine whether HELLP is associated with AT1-AA. The positive rate and titer of AT1-AA in plasma from pregnant women were determined, and the correlation of AT1-AA titer with the grade of HELLP was analyzed. A HELLP (...) rat model established by intravenous injection of AT1-AA. Our experimental results show the AT1-AA titer and positive rate were significantly higher in HELLP group, and AT1-AA titer were positively correlated with the level of TNF-α and ET-1 in plasma and the grade of HELLP syndrome. The results of animal experiments showed that the typical features of HELLP in the pregnant rats after AT1-AA injection. The levels of TNF-α and ET-1 in plasma and liver tissue were significantly increased in AT1-AA

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2018 Scientific reports

15. HELLP Syndrome Complicated By Pulmonary Edema: A Case Report (PubMed)

HELLP Syndrome Complicated By Pulmonary Edema: A Case Report HELLP syndrome is a combination of symptoms described as hemolysis, elevated liver enzymes and low platelets. HELLP is a common life-threatening complication of pregnancy thought to be a variant or complication of preeclampsia. In this case report, we aimed to present a woman with acute postpartum HELLP syndrome complicated by pulmonary edema after caesarean section following severe preeclampsia. Our experience suggests that early (...) detection of HELLP syndrome and timely management will bring good outcomes.

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2018 Open Medicine

16. FAS A-670G and Fas Ligand IVS2nt A 124G polymorphisms are significantly increased in women with preeclampsia and may contribute to HELLP syndrome: a case-controlled study. (PubMed)

FAS A-670G and Fas Ligand IVS2nt A 124G polymorphisms are significantly increased in women with preeclampsia and may contribute to HELLP syndrome: a case-controlled study. We evaluated the association between the Fas-670A/G and the Fas ligand FasL IVS2nt 124 A/G polymorphisms and the risk of pre-eclampsia and its complications.A case-controlled study.University Hospitals in most areas of Tunisia.We recruited 300 pregnant women who developed pre-eclampsia and 300 age-matched healthy pregnant (...) (30%; P < 0.001). Also, a statistically significant difference was obtained in the distribution of the FasL IVS2nt 124G gene variant when comparing women with pre-eclampsia (43%) with controls (30%; P < 0.001). Interestingly, we found that the carriage of Fas-670G was associated with increased liver enzymes, suggesting an increased prevalence of the haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, a pre-eclampsia complication.The Fas-670G and FasL IVS2nt 124G polymorphisms

2018 BJOG

17. Elastic properties of ascending aorta and ventricular-arterial coupling in women with previous pregnancy complicated by HELLP syndrome. (PubMed)

Elastic properties of ascending aorta and ventricular-arterial coupling in women with previous pregnancy complicated by HELLP syndrome. To compare the elastic properties of the ascending aorta and ventricular-arterial coupling (VAC) in women with a previous pregnancy complicated by hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, women who experienced preeclampsia, and healthy controls.Women with a history of preeclampsia (n = 60) or HELLP syndrome (n = 49) and matched (...) and late diastolic retraction velocities, and peak systolic tissue strain (TDI-ε) were determined. VAC was defined as the ratio between aortic elastance (Ea) and left ventricular end-systolic elastance (Ees). All women were free from cardiovascular risk factors.Women with a history of HELLP syndrome showed larger aortas than those with previous preeclampsia or controls, probably related to a higher blood pressure. Aortic elastic properties, including Ea, were similar between HELLP and preeclampsia

2018 Journal of Hypertension

18. Pravastatin for prevention of HELLP syndrome: A case report. (PubMed)

Pravastatin for prevention of HELLP syndrome: A case report. Pravastatin has emerged for prevention and treatment of preeclampsia; no reports are available on pravastatin and HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome.The first pregnancy necessitated termination of pregnancy at gestational age (GA) 20+5 for HELLP. Intrauterine fetal death at GA 22+5 occurred in the second pregnancy, whilst on temporizing management of HELLP.Severe, recurrent early-onset HELLP (...) syndrome.In her fourth pregnancy, pravastatin was commenced at GA 13.The course of pregnancy was uncomplicated, and a healthy, appropriate for gestational age fetus was delivered at term.Pravastatin may be effective in prevention of HELLP. The hepatic uptake may be of particular advantage.

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2017 Medicine

19. Maternal cardiac function after HELLP syndrome: an echocardiography study. (PubMed)

Maternal cardiac function after HELLP syndrome: an echocardiography study. To evaluate maternal hemodynamics in asymptomatic women with a previous pregnancy affected by hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and compare the findings to those of women with previous pre-eclampsia (PE) and controls with a previous uncomplicated pregnancy.Women with a history of PE (n = 60) or HELLP syndrome (n = 49) and matched healthy controls (n = 60) underwent echocardiography at 6 (...)  months to 4 years after delivery, recording left ventricular (LV) dimensions, ejection fraction (LVEF) and mass, right ventricular (RV) tricuspid annular plane systolic excursion and fractional area change (FAC). Diastolic filling (E/A and E/E' ratios) and tissue Doppler imaging were evaluated for both ventricles and the myocardial performance index was calculated.Only women with previous HELLP syndrome showed significant LV concentric hypertrophy (20.4%). However, in both HELLP and PE groups, LV

2017 Ultrasound in Obstetrics and Gynecology

20. Life-threatening bleeding from gastric dieulafoy's lesion in a pregnant woman with hellp syndrome: a case report and literature review. (PubMed)

Life-threatening bleeding from gastric dieulafoy's lesion in a pregnant woman with hellp syndrome: a case report and literature review. Dieulafoy's lesion (DL) is one of the rare causes of upper gastrointestional bleeding. This disease is characterized by small sub-mucosal arteriole that eroded the stomach mucosa and cause severe upper GI bleeding without obvious ulceration. The most common location is fundus area of stomach and usually affects patients over 50 years of age with multiple (...) comorbidities.We report a case of life-threatening bleeding from DL during late pregnancy 31 weeks. Hemoclips were used twice through upper endoscopy with successful hemostasis. Unfortunately, she developed HELLP syndrome diagnosed 5 days after the GI bleeding was stopped. Her pregnancy had to be terminated with delivery of a premature infant. She recovered from her illness and discharged from hospital uneventfully. There is no current report in literature of DL in pregnant woman subsequently suffered HELLP

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2017 BMC Gastroenterology

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