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The recurrence risk of the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP) in subsequent gestations
224
Citafions from the literature /International
Endotbelimndependent in pregnancy
Journal of Gynecology & Obstetrics 50 (1995) 217-226
relaxation of human resistance arteries
McCarthy A.L.; Taylor P.; Graves J.; Raju SK.; Poston L. GBR
AM J OBSTET GYNECOL 1994 171/S(1309-1315) Objective: Reduced peripheral vascular resistance is an integral component of vascular adaptation in pregnancy. The precisemediators of the reduced resistanceare unknown, however, and are often assessedby indirect means. In this study we investigated endothelium-dependent relaxation directly by examining acetylcholine-mediated relaxation in small arteries dissectedfrom the subcutaneousfat layer undergoing biopsy at the time of gynecologic surgery and cesareansection. Study design: By meansof a small vesselmyograph we measuredtension in resistancearteries of normal pregnant (n = 22) and nonpmgnant (n = 10) women and assessed the contributions of vasodilatory prostanoids and endothelium-derived relaxing factor on endothelium-dependent relaxation, as elicited by acetylcholine (1 nmol/l to 10 pmol/L) after precontraction with 3 cmol/l norepinephrine. Results: Endothelium-dependent relaxation was similar in arteries of pregnant and nonpregnant women. Sodium nitroprusside-induced relaxation was similar in arteries of pregnant and nonpregnant women. Conclusion: This study fails to demonstrate any increase in acetylcholineinduced endothelium-dependent relaxation in small subcutaneous arteries in pregnancy. The effects of labor on maternal and fetal levels of insulin-like growth factor binding protein-l
Hills F.A.; Crawford R.; Harding S.; Farkas A.; Chard T. GBR
AM J OBSTET GYNECOL 1994 171/5(1292-1295) Objective: Our purpose was to determine the effects of labor and fetal hypoxia on the levels of insulin-like growth factor binding protein-l in the maternal and fetal circulation Study design: Serum levels of insulin-like growth factor binding protein-l were determined in maternal and umbilical blood at delivery in two groups. The first group included 43 vaginal deliveries and 23 ps. elective cesareansections.The secondgroup consistedof 44 women; in 24 the liquor was meconium stained and in 20 it was clear. Results: Levels of insulin-like growth factor binding protein-l in the neonate were lower deliveries occurring before onset of labor @ < 0.001, Mann-Whitney U test) and higher in cases with severe meconium staining (p = 0.01). There were no differences in maternal levels of insulin-like growth factor binding protein-l between subjects in labor and not in labor or those with or without meconium staining. Conclusion: The process of labor leads to an increase in fetal levels of insulin-like growth factor binding protein-l. This increase may well be associated With the relative fetal stressthat occurs during labor. This suggestion,issupported by the Ending of the highest levels in labors in which there was thick staining of the liquor. The recurrence risk of the sydrome of bemolysi4 elevated liver enzymes, and low platelets (HELLP) in subsequent gestetions
Sullivan C.A.; Magann E.F.; Perry K.G. Jr.; Roberts W.E.; Blake P.G.; Martin J.N. Jr.
USA
AM J OBSTET GYNECOL 1994 171/4 (940-943) Objective: Although it is an important clinical issue,accurate prediction of recurrence risk for the syndrome of hemolysis, elevated liver enzymes, and low platelet’s (HELLP) has been problematic because of limited patient experience. This study was undertaken to determine the likelihood that this form of severe preeclampsia-eclampsiaor any other hypertensive disorder would occur in a subsequentpregnancy. Study design: An extensive retrospective analysis of medical records and patient follow-up regarding subsequent pregnancy outcome were undertaken for the 481 patients with HELLP syndrome managed at this tertiary medical center between Jan. 1, 1980,and Oct. 30, 1991.The Mississippi three-classsystem was used to define severity of diseaseon the basis of the lowest observed perinatal platelet count (class 1 s SO,OOO/~l, class 2 >5O,OOO/~lto lOO,OOO/pl, and class 3 > 1OO,OOO/pl to 5; 150,000/~1.Results: Subsequent gestations (n = 195) occurred in 122 of 481 patients. Evaluable data were available for analysis in 161 of 195 possible pregnancies. Seventy-eight (48%) pregnancies were complicated by sometype of hypertensive disorder, 44 (27%) of which had class 1, 2, or 3 HELLP syndrome. Non-HELLP preeclampsia-eclampsiawas detected in 25 subsequent gestations (15%). Thus, the total frequency of preeclampsia was 69 in 161(43%). If the data for class 3 HELLP are completely excluded from the analysis, 81 subsequent evaluable and viable gestations were identified, 19 pregnancies with preeclampsiaeclampsia(23%) and 15patients with HELLP syndrome (19%), for a total recurrence rate of 42%. Subsequent HELLP gestations were frequently delivered abdominally (64%) on average 2 weeks later than the index pregnancy (32.6 * 5.0 weeks versus34.7 f 5.3 weeks). Delivery at < 32 weeks conferred a high risk (61%) for a similar pretenn delivery in a subsequentgestation. Conclusion: The risk of recurrence of the HELLP syndrome in our population is I9 to 27%. When data from all pregnancieswith all forms of preeclampsia are considered, the risk of recurrencefor any type of preeclampsia-eclampsiais 42 to 43%. A previous preterm delivery is a very high risk factor for recurrence of prematurity with preeclampsia eclampsia. Fii trimester maternal sermn pregnancy-associated plasma protein A and pregmmcy-specitic l-glycoprotein in fetal trisomies
Bersinger N.A.; Brizot M.L.; Johnson A.; Snijders R.J.M.; Abbott J.; Schneider H.; Nicolaides K.H. GBR
BR J OBSTET GYNAECOL 1994 101/l I (970-974) Objective. To examine the potential value of maternal serum levels of pregnancy-associatedplasma protein A (PAPP-A) and pregnancy-specific I-glycoprotein (SPl) in the detection of fetal trisomy. Cross-sectionalstudy. The Harris Birthright Research Centre For Fetal Medicine, King’s College Hospital Medical School, London, UK and Division of Maternal-Fetal Medicine, Jefferson Medical College, Philadelphia, USA. Subjects and methods. Maternal serumPAPP-A and SPl concentrations were measuredat 10 to 13 weeks gestation in samples from 42 pregnancieswith fetal trisomy (trisomy 21, n = 29; trisomy 18, n = 9; trisomy 13,n = 4) and in samplesfrom 210 matched controls. Results. In controls, both maternal serum PAPP-A and
Citafions from the literature /International
Endotbelimndependent in pregnancy
Journal of Gynecology & Obstetrics 50 (1995) 217-226
relaxation of human resistance arteries
McCarthy A.L.; Taylor P.; Graves J.; Raju SK.; Poston L. GBR
AM J OBSTET GYNECOL 1994 171/S(1309-1315) Objective: Reduced peripheral vascular resistance is an integral component of vascular adaptation in pregnancy. The precisemediators of the reduced resistanceare unknown, however, and are often assessedby indirect means. In this study we investigated endothelium-dependent relaxation directly by examining acetylcholine-mediated relaxation in small arteries dissectedfrom the subcutaneousfat layer undergoing biopsy at the time of gynecologic surgery and cesareansection. Study design: By meansof a small vesselmyograph we measuredtension in resistancearteries of normal pregnant (n = 22) and nonpmgnant (n = 10) women and assessed the contributions of vasodilatory prostanoids and endothelium-derived relaxing factor on endothelium-dependent relaxation, as elicited by acetylcholine (1 nmol/l to 10 pmol/L) after precontraction with 3 cmol/l norepinephrine. Results: Endothelium-dependent relaxation was similar in arteries of pregnant and nonpregnant women. Sodium nitroprusside-induced relaxation was similar in arteries of pregnant and nonpregnant women. Conclusion: This study fails to demonstrate any increase in acetylcholineinduced endothelium-dependent relaxation in small subcutaneous arteries in pregnancy. The effects of labor on maternal and fetal levels of insulin-like growth factor binding protein-l
Hills F.A.; Crawford R.; Harding S.; Farkas A.; Chard T. GBR
AM J OBSTET GYNECOL 1994 171/5(1292-1295) Objective: Our purpose was to determine the effects of labor and fetal hypoxia on the levels of insulin-like growth factor binding protein-l in the maternal and fetal circulation Study design: Serum levels of insulin-like growth factor binding protein-l were determined in maternal and umbilical blood at delivery in two groups. The first group included 43 vaginal deliveries and 23 ps. elective cesareansections.The secondgroup consistedof 44 women; in 24 the liquor was meconium stained and in 20 it was clear. Results: Levels of insulin-like growth factor binding protein-l in the neonate were lower deliveries occurring before onset of labor @ < 0.001, Mann-Whitney U test) and higher in cases with severe meconium staining (p = 0.01). There were no differences in maternal levels of insulin-like growth factor binding protein-l between subjects in labor and not in labor or those with or without meconium staining. Conclusion: The process of labor leads to an increase in fetal levels of insulin-like growth factor binding protein-l. This increase may well be associated With the relative fetal stressthat occurs during labor. This suggestion,issupported by the Ending of the highest levels in labors in which there was thick staining of the liquor. The recurrence risk of the sydrome of bemolysi4 elevated liver enzymes, and low platelets (HELLP) in subsequent gestetions
Sullivan C.A.; Magann E.F.; Perry K.G. Jr.; Roberts W.E.; Blake P.G.; Martin J.N. Jr.
USA
AM J OBSTET GYNECOL 1994 171/4 (940-943) Objective: Although it is an important clinical issue,accurate prediction of recurrence risk for the syndrome of hemolysis, elevated liver enzymes, and low platelet’s (HELLP) has been problematic because of limited patient experience. This study was undertaken to determine the likelihood that this form of severe preeclampsia-eclampsiaor any other hypertensive disorder would occur in a subsequentpregnancy. Study design: An extensive retrospective analysis of medical records and patient follow-up regarding subsequent pregnancy outcome were undertaken for the 481 patients with HELLP syndrome managed at this tertiary medical center between Jan. 1, 1980,and Oct. 30, 1991.The Mississippi three-classsystem was used to define severity of diseaseon the basis of the lowest observed perinatal platelet count (class 1 s SO,OOO/~l, class 2 >5O,OOO/~lto lOO,OOO/pl, and class 3 > 1OO,OOO/pl to 5; 150,000/~1.Results: Subsequent gestations (n = 195) occurred in 122 of 481 patients. Evaluable data were available for analysis in 161 of 195 possible pregnancies. Seventy-eight (48%) pregnancies were complicated by sometype of hypertensive disorder, 44 (27%) of which had class 1, 2, or 3 HELLP syndrome. Non-HELLP preeclampsia-eclampsiawas detected in 25 subsequent gestations (15%). Thus, the total frequency of preeclampsia was 69 in 161(43%). If the data for class 3 HELLP are completely excluded from the analysis, 81 subsequent evaluable and viable gestations were identified, 19 pregnancies with preeclampsiaeclampsia(23%) and 15patients with HELLP syndrome (19%), for a total recurrence rate of 42%. Subsequent HELLP gestations were frequently delivered abdominally (64%) on average 2 weeks later than the index pregnancy (32.6 * 5.0 weeks versus34.7 f 5.3 weeks). Delivery at < 32 weeks conferred a high risk (61%) for a similar pretenn delivery in a subsequentgestation. Conclusion: The risk of recurrence of the HELLP syndrome in our population is I9 to 27%. When data from all pregnancieswith all forms of preeclampsia are considered, the risk of recurrencefor any type of preeclampsia-eclampsiais 42 to 43%. A previous preterm delivery is a very high risk factor for recurrence of prematurity with preeclampsia eclampsia. Fii trimester maternal sermn pregnancy-associated plasma protein A and pregmmcy-specitic l-glycoprotein in fetal trisomies
Bersinger N.A.; Brizot M.L.; Johnson A.; Snijders R.J.M.; Abbott J.; Schneider H.; Nicolaides K.H. GBR
BR J OBSTET GYNAECOL 1994 101/l I (970-974) Objective. To examine the potential value of maternal serum levels of pregnancy-associatedplasma protein A (PAPP-A) and pregnancy-specific I-glycoprotein (SPl) in the detection of fetal trisomy. Cross-sectionalstudy. The Harris Birthright Research Centre For Fetal Medicine, King’s College Hospital Medical School, London, UK and Division of Maternal-Fetal Medicine, Jefferson Medical College, Philadelphia, USA. Subjects and methods. Maternal serumPAPP-A and SPl concentrations were measuredat 10 to 13 weeks gestation in samples from 42 pregnancieswith fetal trisomy (trisomy 21, n = 29; trisomy 18, n = 9; trisomy 13,n = 4) and in samplesfrom 210 matched controls. Results. In controls, both maternal serum PAPP-A and