Spontaneous hepatic rupture, which is a complication of hypertension in pregnancy, is extremely rare. However, high maternal and perinatal mortality rates are observed. Several factors, namely, age over 30 years, multiparity, severe preeclampsia, or HELLP syndrome (a group of symptoms which include hemolytic anemia, hepatic enzyme increase, and thrombocytopenia), are associated with this condition. An autopsy case of a woman with twin pregnancy was studied. She was at 36 weeks of gestational age and suffered from the sudden development and rapid progression of hypertension. Moreover, she died because of spontaneous hepatic rupture despite an emergency operation. Autopsy revealed a capsular rupture of the right lobe of the liver with numerous blood clots and hypovolemic signs, such as weak postmortem lividity and palor of the skin and conjunctiva. A close examination of the trunk and liver for the classification of the cause of rupture and an assessment of medical history, such as preeclampsia, are needed during postmortem examination of pregnant women with hepatic rupture or her fetus. To the best of our knowledge, this fatal complication in pregnant women is not yet presented in postmortem examinations in Korea. Thus, we report the findings of this case to share the knowledge.
Anemia, Hemolytic ; Autopsy* ; Classification ; Conjunctiva ; Emergencies ; Female ; Fetus ; Gestational Age ; HELLP Syndrome ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced ; Hypovolemia ; Korea ; Liver ; Parity ; Perinatal Mortality ; Pre-Eclampsia* ; Pregnancy ; Pregnancy, Twin ; Pregnant Women* ; Rupture* ; Rupture, Spontaneous ; Skin

Hypertension is the most common medical disorder encountered in pregnancy, complicating 5% to 10% of all pregnancies. It is a major cause of maternal, fetal and newborn morbidity and mortality, increasing the risk of cerebrovascular events, organ failure and placenta abruptio in mothers and the risk of intrauterine growth restriction, prematurity and intrauterine death in fetuses. There are four types of hypertensive disorders in pregnancy: gestational hypertension, preeclampsia and eclampsia syndrome, chronic hypertension of any etiology, and Preeclampsia superimposed on chronic hypertension. The decision to treat hypertension in pregnancy should consider the benefit-harm balance for both mother and fetus, and depends on gestational age, blood pressure levels, and presence of preeclampsia. As termination of pregnancy is the only cure for preeclampsia, there is general agreement that delivery rather than observation is suggested in women with severe preeclampsia, eclampsia, or mild hypertension at term. However, it is not clear whether women with mild hypertension at near term can be managed expectantly as well as whether antihypertensive therapy for mild to moderate hypertension should be initiated. In 2013, the American College of Obstetricians and Gynecologists provided evidence-based recommendations for the management of patients with hypertension during and after pregnancy, but it concluded that the final decision should be individualized and made by the health care provider and patient in all instances. Therefore, well-designed large trials are needed to clarify the indication for antihypertensive use and the selected population who would benefit from expectant management for mild to moderate hypertension at preterm.
Blood Pressure ; Disease Management ; Eclampsia ; Female ; Fetus ; Gestational Age ; Health Personnel ; Humans ; Hypertension* ; Hypertension, Pregnancy-Induced ; Infant, Newborn ; Mortality ; Mothers ; Placenta ; Pre-Eclampsia ; Pregnancy*

The diagnosis of HELLP syndrome associated with preeclampsia-eclampsia during pregnancy uses three test results, including hemolysis, elevated liver enzyme, low platelets and their related clinical symptoms. Liver rupture is a life-threatening and rare complication related to HELLP syndrome. Early diagnosis and rapid treatment are very important for protecting the life of the patient and the fetus. We are reporting an anesthetic experience a sudden-onset suspicious HELLP syndrome with an intraperitoneal hemorrhage caused by a rapidly progressed liver rupture in a severe preeclampsia patient without any abnormalities during gestation.
Diagnosis ; Early Diagnosis ; Eclampsia ; Female ; Fetus ; HELLP Syndrome* ; Hemolysis ; Hemorrhage* ; Humans ; Liver* ; Pre-Eclampsia* ; Pregnancy ; Rupture*

OBJECTIVE: In the pathogenesis of pre-eclampsia, endothelial cell activation or dysfunction is the central theme and marked dyslipidemia may contribute to endothelial cell dysfunction. The objective of this study was to evaluate the association between pre-eclampsia and the Asp9Asn mutation and the -93G promotor mutation. STUDY DESIGN: DNA was extracted from whole blood or cheek swabs of 224 pre-eclamptic patients, 265 controls, and 106 babies from pre-eclamptic patients. Controls consisted of women who had undergone at least two term pregnancies unaffected by pre-eclampsia. All samples were genotyped for all the polymorphisms using Polymerase Chain Reaction (PCR) of known allelic variants. Sequences were confirmed on an Applied Biosystems 373 DNA Sequencer. Results were analyzed with a x2 contingency table. RESULTS: The prevalences of the LPL Asp9Asn mutation and the LPL -93G promotor mutation were not significantly different between the patients with pre-eclamptic patients, severe pre-eclamptic patients, and HELLP syndrome patients and controls and also not significantly different between the babies born from pre-eclamptic mothers and controls. CONCLUSION: In this caucasian population, the LPL Asp9Asn mutation and the LPL -93G promotor mutation are not associated with an increased risk for pre-eclampsia and HELLP syndrome.
Cheek ; DNA ; Dyslipidemias ; Endothelial Cells ; Female ; HELLP Syndrome ; Humans ; Hypertension, Pregnancy-Induced* ; Lipoprotein Lipase* ; Lipoproteins* ; Mothers ; Polymerase Chain Reaction ; Pre-Eclampsia ; Pregnancy ; Prevalence

OBJECTIVE: Proteinuria is a major clinical manifestation as well as hypertension and generalized edema in pregnancy-induced hypertension(PIH) and it should be considered an important marker of perinatal outcome. We studied the impact of proteinuria on maternal and perinatal outcome according to the degree of urine protein in PIH. METHODS: Maternal urine protein and serum albumin levels were studied in 64 cases of PIH who were admitted to Department of Obstetrics and Gynecology, Pil-Dong Hospital, College of Medicine, Chung-Ang University for the period of 10 years from January 1, 1989 to December 31, 1998. RESULTS: Serum albumin level was 2.9+/-0.7g/dL in mild preeclampsia group and 2.7+/-0.7g/dL in severe peeclampsia group and there was a significant difference between them. Birth weight of infant was 3001+/-659g in mild preeclampsia group and 2446+/-878g in severe peeclampsia group, and there was a significant difference between them. 1 minute Apgar score was 8.4+/-2.4 and 7.6+/-3.4, respectively and there was a significant difference between them. 5 minute Apgar score was 9.5+/-1.8 and 8.4+/-2.9, respectively and there was a significant difference between them. There were several maternal complications above 2(+) urine protein and no maternal complications below 1(+) urine protein. Small for gestational age infant was more common above 2(+) urine protein than below 1(+) urine protein and fetal death was more common in 3(+) urine protein. CONCLUSIONS: There was a decreasing trend in gestational weeks at delivery as proteinuria become more severe and also in birth weight, 1 minute Apgar score and 5 minute Apgar score. Maternal and fetal complications were more common as proteinuria become more severe.
Apgar Score ; Birth Weight ; Edema ; Female ; Fetal Death ; Gestational Age ; Gynecology ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced* ; Infant ; Obstetrics ; Pre-Eclampsia ; Pregnancy ; Proteinuria* ; Serum Albumin

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.
Abortion, Induced ; adverse effects ; Adult ; Antiphospholipid Syndrome ; complications ; Eclampsia ; etiology ; Female ; HELLP Syndrome ; etiology ; Humans ; Pre-Eclampsia ; physiopathology ; Pregnancy

Hepatic infarction is a rare but potentially life-threatening complication of pregnancy-associated preeclampsia or HELLP (hemolysis, elevated liver function tests, low platelets) syndrome. We present a case of hepatic infarction subsequent to HELLP syndrome and occurring during the immediate postpartum, and the associated radiologic findings. Sonography revealed poorly defined hypoechoic zones of infarctioin. Computed tomography(CT) demonstrated the characteristic features of nonenhancing, low attenuation, relatively well-defined, wedge shaped or geographic hepatic lesions, without mass effect.
Female ; HELLP Syndrome* ; Infarction* ; Liver Function Tests ; Postpartum Period ; Pre-Eclampsia ; Pregnancy

OBJECTIVE: This study was performed to know whether toxemia occurred more frequently in pregnancy which is achieved despite of azoospermia or severe oligospermia. METHODS: We selected 31 women who underwent surgical sperm aspiration and ICSI at Seoul National University Hospital (SNUH) from 1995 to 2001 and pregnancy continued over 20 gestational age as study group. And as a comparison group, 19 women who underwent ICSI at SNUH from 1995 to 2001 with no semen analysis abnormality and pregnancy continued over 20 gestational age were selected. The incidence of toxemia in both groups was observed. RESULTS: There were no differences in the incidence of gestational hypertension and preeclampsia between groups (RR=3.46, 95%CI 0.37-32.18) (RR=0.91, 95%CI 0.14-6.02). CONCLUSION: No association was observed between preconceptional sperm exposure to female genital tract and the incidence of toxemia.
Azoospermia ; Female* ; Gestational Age ; Humans ; Hypertension, Pregnancy-Induced ; Incidence ; Male ; Oligospermia ; Pre-Eclampsia ; Pregnancy* ; Semen Analysis ; Seoul ; Sperm Injections, Intracytoplasmic ; Sperm Retrieval ; Spermatozoa* ; Toxemia

Objective: To investigate the impact of obstructive sleep apnea syndrome (OSAS) on pregnancy outcomes, especially the relationship between OSAS and hypertensive disorders in pregnancy (HDP). Methods: A total of 228 pregnant women with high risk of OSAS who underwent sleep monitoring during pregnancy in Peking University People's Hospital from January 2021 to April 2022 were collected by reviewing their medical records for retrospective analysis. According to the diagnosis of OSAS, the pregnant women were divided into OSAS group (105 cases) and non-OSAS group (123 cases). The non-parametric Mann-Whitney U test, χ² test or Fisher's exact test were used to compare the general data and maternal and fetal outcomes between the two groups, and the occurrence of each type of HDP was further compared. Results: (1) Compared with the non-OSAS group, the median pre-pregnancy body mass index (23.6 vs 27.6 kg/m²) and the proportion of snoring [28.9% (33/114) vs 59.2% (61/103)] in the OSAS group were higher, and the differences were both statistically significant (both P<0.001). (2) The incidence of HDP [67.6% (71/105) vs 39.0% (48/123)] and gestational diabetes mellitus [GDM; 40.0% (42/105) vs 26.8% (33/123)] of pregnant women in the OSAS group were higher than those in the non-OSAS group, and the median delivery week was shorter than that in the non-OSAS group (38.4 vs 39.0 weeks). The differences were all statistically significant (all P<0.05). Between-group differences for the delivery way, postpartum hemorrhage, the rate of intensive care unit admission, preterm birth, small for gestational age infants, neonatal asphyxia, the rate of neonatal intensive care unit admission, newborn birth weight and the proportion of umbilical artery blood pH<7.00 were not statistically significant (all P>0.05). (3) Compared with the non-OSAS group, the incidence of chronic hypertension [11.4% (14/123) vs 22.9% (24/105)] and chronic hypertension with superimposed pre-eclampsia [11.4% (14/123) vs 30.5% (32/105)] were higher in the OSAS group, and the differences were both statistically significant (both P<0.01). Conclusion: OSAS is related to HDP (especially chronic hypertension and chronic hypertension with superimposed pre-eclampsia) and GDM, which could provide a practical basis for the screening, diagnosis and treatment of OSAS in pregnant women at high risk.
Infant, Newborn ; Pregnancy ; Infant ; Humans ; Female ; Pre-Eclampsia/epidemiology* ; Hypertension, Pregnancy-Induced/epidemiology* ; Retrospective Studies ; Premature Birth ; Sleep Apnea, Obstructive/epidemiology* ; Diabetes, Gestational/epidemiology*

OBJECTIVE: The purpose of this study was to assess the impact of vascular endothelial growth factor (VEGF) in pregnancies with mild and severe preeclampsia. METHODS: From January 1999 to June 2001, we studied the severity for pregnant women with pregnancy induced hypertension between 28 and 40 weeks gestation. In the mild (n=46) and severe preeclamptic women (n=28), the laboratory evaluation included liver function test, platelet counts, and serum creatinine. The systolic/diastolic (S/D) ratio of the fetal umbilical artery flow for placental resistance was measured by ultrasonographic doppler velocimetry. To detect the damage of vascular endothelial cells in all preeclamptic women, serum concentrations of VEGF were measured. RESULTS: Severe preeclampsia had more elevated liver enzymes, thrombocytopenia, high creatinine than mild preeclampsia. HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) was encountered in 8/28 (28.6%) of severe preeclampsia. Fifteen out of twenty-eight cases (53.6%) in severe preeclampsia had elevated S/D ratio from 3.0 to 4.5 including 6 cases with absent end diastolic velocity, whereas 4/46 (8.7%) was elevated SD ratio (>3.0) in mild preeclampsia. Serum concentrations of VEGF were elevated in both mild (7.5+/-4.9 ng/mL, p<0.05) and severe preeclampsia (19.3+/-8.8 ng/mL, p<0.05) compared to normal pregnancy (0.5~2.1 ng/mL). CONCLUSION: The higher serum concentration of VEGF and elevated S/D ratio of umbilical artery were responsible for the changes of the resistance of placental blood flow in severe preeclampsia. Furthermore, elevated S/D ratio of umbilical artery velocity was essential as a surveillance method of fetal health status with IUGR (Intrauterine growth restriction) by vascular declination of placenta.
Creatinine ; Endothelial Cells ; Female ; Fetal Growth Retardation ; HELLP Syndrome ; Humans ; Hypertension, Pregnancy-Induced ; Liver ; Liver Function Tests ; Placenta ; Platelet Count ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women ; Rheology ; Thrombocytopenia ; Umbilical Arteries ; Vascular Endothelial Growth Factor A*