The present study compares neonatal outcome after preterm delivery of infants in pregnancies complicated by the HELLP syndrome or severe preeclampsia (PS). The maternal and neonatal charts of 71 out of a total of 409 pregnancies that were complicated by hypertensive disorders at Severance hospital between January 1995 and December 2004 were reviewed. Twenty-one pregnancies were complicated by HELLP syndrome and 50 pregnancies were complicated by PS. Fifty normotensive (NT) patients who delivered because of preterm labor comprised the control group. Results were analyzed by the chi-square test and ANOVA. Gestational age and maternal age at delivery were matched among the three groups. The neonatal outcomes of the HELLP syndrome group were compared with the PS and NT groups. There were significant differences between the HELLP syndrome group and the PS group in the incidence of intraventricular hemorrhage (IVH) (61.9% vs. 26%, p=0.006), sepsis (85.7% vs. 44%, p =0.003) and mechanical ventilation (MV) rate (81% vs. 54%, p=0.039). There were significant differences between the HELLP syndrome group and the NT group in the incidence of neonatal death (ND) (19.5% vs. 2.0%, p=0.034), respiratory distress syndrome (RDS) (38.1% vs. 8%, p=0.0045), IVH (61.9% vs. 4%, p < 0.0001), sepsis (85.7% vs. 14%, p < 0.0001), intensive care (IC) (85.7% vs. 24%, p < 0.0001) and MV rate (80.1% vs. 14%, p < 0.0001). There were also significant differences between the PS and NT groups in the incidence of ND (20% vs. 2%, p=0.0192), RDS (30% vs. 8%, p=0.0085), IVH (26% vs. 4%, p=0.0070), sepsis (44% vs. 14%, p=0.0015), IC (78% vs. 24%, p < 0.0001), MV rate (54% vs. 14%, p < 0.0001) and low 5-min APGAR score (50% vs. 16%, p=0.0005). This study shows increased morbidity in newborns of mothers complicated with HELLP syndrome and indicates that early, regular and high quality management of these patients is essential to improve both maternal and neonatal outcome.
Premature Birth/*mortality ; Pregnancy Outcome/*epidemiology ; Pregnancy ; Pre-Eclampsia/mortality ; Male ; Infant, Newborn ; Humans ; HELLP Syndrome/*mortality ; Female ; Adult

Hepatocellular carcinoma associated with pregnancy is rarely encountered, since hepatocellular carcinoma is usually developed after childbearing ages and severe menstrual irregularity and infertility with disturbance of estrogen metabolism is often accompanied with cirrhosis that is a most common underlying disease of primary hepatocellular carcinoma. Spontaneous hepatic rupture in pregnancy is a rare condition associated with significant maternal and perinatal mortality and could be developed related with severe preeclampsia and especially HELLP syndrome but possible related with hepatocellular carcinoma. We report a case of spontaneous hepatic rupture during the puerperium in a patient with hepatocellular carcinoma with a brief review of literatures.
Carcinoma, Hepatocellular* ; Estrogens ; Female ; Fibrosis ; HELLP Syndrome ; Humans ; Infertility ; Metabolism ; Perinatal Mortality ; Postpartum Period* ; Pre-Eclampsia ; Pregnancy ; Rupture*

Thrombotic thrombocytopenic purpura (TTP) is quiet rare, with 1 of 25,000 delivery and complicating pregnancy is associated with high maternal mortality and long-term morbidity. Unfortunately the clinical appearance of thrombotic thrombocytopenic purpura is similar with the syndrome of hemolysis, elevated liver enzyme, and low platelet (HELLP), but the treatment of this differs from that of the HELLP syndrome or acute fatty liver of pregnancy, therefore accurate diagnosis is essential for optimal therapy. The survival of this disorder has been improved due to aggressive treatment with plasma transfusion or plasmapheresis. We have experienced a case of thrombotic thrombocytopenic purpura confused with HELLP syndrome of preeclampsia, so we report it with a brief review of literature.
Blood Platelets ; Diagnosis ; Fatty Liver ; Female ; HELLP Syndrome ; Hemolysis ; Liver ; Maternal Mortality ; Plasma ; Plasmapheresis ; Pre-Eclampsia ; Pregnancy* ; Purpura, Thrombotic Thrombocytopenic*

OBJECTIVE: To assess the clinical characteristics, laboratory findings, the maternal and neonatal complications between HELLP syndrome and severe preeclampsia. METHODS: We reviewed the material and neonatal charts of 34 pregnancies complicated by HELLP syndrome and 40 pregnancies complicated by severe preeclampsia managed at our hospital between January, 2001 and December, 2005. We compared the clinical characteristics, laboratory findings, the maternal and neonatal complications between two groups. Results were compared by student T test, chi-square test. RESULTS: Our study showed that in HELLP syndrome patients had the less gestational age at admission, gestational age at delivery, the lower platelet counts, the higher AST, ALT, LDH, and the longer hospitalization period than in severe preeclampsia. Steroid (dexamethasone) use, cesarean delivery rate and MgSO4 use were more frequent in HELLP syndrome than severe preeclampsia. Neonatal birth weight was lower with HELLP syndrome. There was no significant difference in maternal and neonatal complications. CONCLUSION: HELLP syndrome need to be recognized a unique form of severe preeclampsia. It was associated with serious maternal and fetal mortality, the appropriate management would be done by early diagnosis using laboratory tests.
Birth Weight ; Early Diagnosis ; Female ; Fetal Mortality ; Gestational Age ; HELLP Syndrome* ; Hospitalization ; Humans ; Platelet Count ; Pre-Eclampsia* ; Pregnancy

Eclampsia is defined as the occurrence of convulsions, not caused by any coincidental neurologic disease such as epilepsy, in a woman whose condition also meets the criteria for preeclampsia. Intracerebral hemorrhage with eclampsia is rare but maternal mortality is 30-40%. Fetal outcome parallels that of the mother and reflects the maternal condition as well as gestational age at delivery. With noninvasive imaging technique of CT, the early diagnosis and proper management of intracerebral hemorrhage in a patient can be achieved. The syndrome of Hemolysis, Elevated Liver enzyme, Low Platelets (HELLP) is considered to be complication of severe preeclampsia-eclampsia. We report a case of intracerebral hemorrhage and HELLP syndrome in a patient with eclampsia.
Cerebral Hemorrhage* ; Early Diagnosis ; Eclampsia* ; Epilepsy ; Female ; Gestational Age ; HELLP Syndrome* ; Hemolysis ; Humans ; Liver ; Maternal Mortality ; Mothers ; Pre-Eclampsia ; Pregnancy ; Seizures

The HELLP syndrome(hemolysis, elevated liver enzymes, and low platelets) is a complication of severe preeclampsia or eclampsia and associated with increased maternal and perinatal mortality. Exact pathogenic mechanism is still unclear but the microangiopathic hemolytic anemia combined with endothelial cell damage is suspected to be closely associated with disease process. Variable degree of disseminated intravascular coagulation(DIC) may be accompanied with the HELLP syndrome. We report a case of postpartum HELLP syndrome. She is 24 year-old woman. She showed definite evidence of microangiopathic hemolytic anemia, DIC, elevated liver enzymes and acute renal failure. Liver biopsy revealed fatty change with focal fibrin like material deposition in the portal tract area. She recovered completely with conservative treatment in 2 weeks.
Acute Kidney Injury* ; Anemia, Hemolytic ; Biopsy ; Dacarbazine ; Eclampsia ; Endothelial Cells ; Female ; Fibrin ; HELLP Syndrome* ; Humans ; Liver ; Perinatal Mortality ; Postpartum Period ; Pre-Eclampsia ; Pregnancy ; Young Adult

OBJECTIVE: To identify risk factors for maternal morbidity in eclamptic woman. METHODS: A retrospective analysis was performed on the record of eclamptic woman during from August 1989 to February 2002. Univariate analysis was used to determine which of the independent variables were significantly different between two groups (antepartum vs postpartum). RESULTS: The incidence of eclampsia was 1 in 1,795 deliveries and the maternal mortality rate was 4.3%. Maternal complications associated with eclampsia were abruptio placentae (13.0%), pulmonary edema (26.1%), acute renal failure (39.1%), HELLP syndrome (30.4%), disseminated intravascular coagulopathy (8.7%), neurologic sequelae (8.7%), maternal death (4.3%). One patient died from disseminated intra- vascular coagulopathy, sepsis, and multiorgan failure after postpartum eclampsia. Women with antepartum eclampsia had higher incidence of acute renal failure (44.4% vs 20%) and HELLP syndrome (33.3% vs 20%) than did in women with postpartum eclampsia. Conversely, women with postpartum eclampsia had higher incidence of disseminated intravascular coagulopathy (6.7% vs 20%) and neurologic sequelae (6.7% vs 20%). CONCLUSION: Early detection and management of preeclampsia can prevent the eclampsia and maternal mortality and morbidity.
Abruptio Placentae ; Acute Kidney Injury ; Eclampsia ; Female ; HELLP Syndrome ; Humans ; Incidence ; Maternal Death ; Maternal Mortality ; Postpartum Period ; Pre-Eclampsia ; Pregnancy ; Pulmonary Edema ; Retrospective Studies ; Risk Factors* ; Sepsis

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

OBJECTIVE: Our purpose was to describe the clinical progress and the maternal and fetal outcome in 16 pregnancies complicated by the HELLP(hemolysis, elevated liver enzymes, low platelet). Material: We reviewed the maternal and neonatal charts from 16 consecutive pregnancies complicated by the HELLP syndrome among 302 pregnancies complicated by preeclamsia and eclamsia managed at our hospital during the period of 4 years from June 1994 through June 1998. The HELLP syndrome was defined by previously published laboratory criteria. We assessed the time of onset, presenting symptom, laboratory finding, mode of delivery, fetal and maternal complication in each case. We also reviewed the clinical finding in detail in the case resulted in maternal death. RESULTS: In regards to the time of onset, 15 cases (93.7%) occurred at antepartum period and only 1 case (6.2%) occurred at postpartum period. Among the 15 cases occurred at antepartum period, 13 cases (81.25%) developed at 27 to 36 weeks gestation and 2 cases (12.5%) developed at near term. In regards to the presenting symptom, twelve patients (75%) complained of right upper quardrant or epigastric pain. Of 16 patients, 12 patients (75%) experienced headache and 10 patients (62.5%) complained of nausea, or vomiting and 5 patients (31.2%) had visual disturbance. The laboratory finding of all 16 cases were as follow; the mean level of platelet: 68700/mm3 (range: 48000 to 91700), the mean level of serum asparate aminotransferase: 335 IU/L (range: 62 to 135), the mean level of lactic dehydrogenase: 910 IU/L (range: 558 to 5794), and the mean level of total bilirubin: 2.6 mg/dl (range: 0.7 to 10.4). To review the mode of delivery, cesarean sections were done on 10 patients (62.5%) including 7(43.7%) emergency and 3(18.7%) elective operations. However, 6 patients (37.5%) delivered vaginally. Maternal complications were as follow; abruptio placenta in 1 case (6.2%), DIC in 2 cases (12.5%), pulmonary edema in 3 cases (18.7%), pleural effusion in 4 cases (25%), renal failure in 4 cases (25%), and 1 case of death. Fetal and neonatal outcome was assessed; 9 cases of intrauterine growth retardation (56.2%), meconium stained in 3 cases (18.7%), 2 stillbirth (12.5%), and 2 neonatal death (12.5%). CONCLUSION: HELLP syndrome is associated with serious maternal and fetal morbidity and mortality.
Bilirubin ; Blood Platelets ; Cesarean Section ; Dacarbazine ; Emergencies ; Female ; Fetal Growth Retardation ; Headache ; HELLP Syndrome ; Hemolysis* ; Humans ; Liver* ; Maternal Death ; Meconium ; Mortality ; Nausea ; Oxidoreductases ; Placenta ; Pleural Effusion ; Postpartum Period ; Pregnancy* ; Pulmonary Edema ; Renal Insufficiency ; Stillbirth ; Vomiting