Hepatic histopathologic condition does not correlate with laboratory abnormalities in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count)

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of pregnancy-induced hypertension among women sharing HLA antigens with their spouses or fetuses, thus supporting the hypothesis that maternal sensitization to fetal HLA alloantigens reduces the risk for pregnancy-induced hypertension. However, not all studies have confirmed these findings. No investigators have examined the four different types of maternalfetal HLA relationships in their studies of pregnancy-induced hypertension. Our goal was to examine such associations to test further the HLA allosensitization hypothesis. Methods: We conducted a cohort study of pregnancy-induced hypertension among 683 nulliparous women. Women and their neonates were typed for HLA-A,-B,-DR, and -DQ antigens using serologic techniques to establish maternal-fetal relationships. Results: We found an increased prevalence of pregnancyinduced hypertension when the fetus, but not the mother, was potentially exposed to HLA-DR alloantigens (maternal allogenicity) compared with the other three conditions combined (P < 0.003). Controlling for confounding factors, the increased prevalence of pregnancy-induced hypertension persisted in situations of maternal HLA-DR allogenicity (P < 0.007). Conclusions: Based upon our observations and other immunologic studies of pregnancy-induced hypertensive and uncomplicated pregnancies, we conclude that a maternal humoral response against fetal anti-HLA-DR immunoglobulin (IgG) antibody may influence the development of pregnancyinduced hypertension. This could occur when an immunocompetent fetus is exposed to maternal HLA-DR alloantigens, maternal exposure to fetal HLA-DR alloantigens is not bears paternally inherited possible, and fetal IgG antibody markers allogeneic to the mother.

Hepatic histopathologic condition does not correlate with laboratory abnormalities in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) Barton J.R.; Riely CA.; Adamec T.A.; Shanklin D.R.; Khoury A.D.; Sibai B.M. USA AM J OBSTET GYNECOL 1992 l67/6 (1538-1543) OBJECTIVE: Our objective was to categorize the histologic findings in the liver in patients with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) and to correlate these findings with the severity of clinical laboratory abnormalities. STUDY DESIGN: Eleven patients with laboratory criteria for HELLP syndrome who required cesarean delivery underwent needle biopsy of the liver under direct visualization. RESULTS: Eight patients had periportal hemorrhage, and six had fibrin deposition. Fatty infiltration was seen in four, one with large-droplet fat, three with microvesicular fat. There was no statistically significant correlation between the severity of the histologic findings of periportal hemorrhage and fibrin deposition and the clinical laboratory findings. Fatty infiltration did not correlate with the severity of the HELLP syndrome’s histologic condition, but, in contrast, did correlate with thrombocytopenia and aminotransferase elevations. CONCLUSIONS: Laboratory abnormalities do not accurately reflect the severity of the underlying histopathologic condition in HELLP syndrome. We propose that all patients with

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HELLP syndrome, regardless of the degree of their laboratory abnormalities, be treated aggressively, primarily with delivery. Alpha thalassemia hydrops fetalis in the UK: The importance of screening pregnant women of Chinese, other South East Asian and Mediterranean extraction for alpha thalassemia trait Petrou M.; Brugiatelli M.; Old J.; Hurley P.; Ward R.H.T.; Wong K.P.; Rodeck C.; Model1 B. GBR BR J OBSTET GYNAECOL 1992 99112 (985-989) Objective: Alpha zero (01’ or a-‘) thalassemia is an important genetic risk for women originating from Hong Kong, Singapore, Vietnam, Thailand, the Philippines or South China. Cypriots are also at risk. Carriers of oy thalassemia trait can be detected by routine hemoglobinopathy screening. When a couple are both carriers, in each pregnancy there is a 25% risk that the fetus will have QLthalassemia hydrops fetalis; this is fatal for the fetus and carries serious obstetric and psychological risks for the mother. Most informed couples at risk request prenatal diagnosis and selective abortion. This study investigates the effectiveness of screening, counselling and prenatal diagnosis for (Ythalassemia hydrops fetalis in the UK. Design: Retrospective analysis of the notes. Subjects: I8 couples attending University College Hospital London for prenatal diagnosis of (Y thalassemia hydrops fetalis since 1982. Results: The study shows underdiagnosis of both o” thalassemia trait and (Y thalassemia hydrops fetalis leading to avoidable stillbirths and complications in pregnancy. Conclusion: We recommend early screening for o” thalassemia trait for all women of Southeast Asian or eastern Mediterranean origin and the offer of prenatal diagnosis when indicated. The diagnosis of (Y thalassemia hydrops fetalis should be considered in women of the relevant ethnic origin who have a stillbirth, neonatal death, abnormal ultrasound findings at fetal anomaly scanning (especially a large placenta), or who develop pre-eclampsia. Association of cervicovaginal infections with increased vaginal fluid phospholipase A, activity McGregor J.A.; French J.I.; Jones W.; Parker R.; Patterson E.: Draper D. USA AM J OBSTET GYNECOL 1992 167/6 (1588-1594) OBJECTIVE: The purpose of this study was to determine if phospholipase A, was detectable within vaginal fluid and to correlate its presence with the presence of common lower genital tract infection or microbial conditions. STUDY DESIGN: Pregnant women were examined at the first prenatal visit with standard clinical evaluations and microbiologic cultures or tests. Vaginal fluid samples were evaluated for phospholipase A2 activity by means of a standardized enzyme fluorometric assay. Data were stratified to control for coexisting infections. RESULTS: Phospholipase A, activity was detected among 29.8% of women and was independently associated with the presence of bacterial vaginosis (P < 0.001). Trichomonus vaginalis (P < 0.04), and Chlamydia trachomatis (P < 0.02). The percentage of women with phospholipase A, activity and the level of activity was increased in the presence of more than one infection. CONCLUSIONS: Elevated reproductive tract Int J G_ynecol 0hsrer 42