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Preeclampsia severa, eclampsia, síndrome de HELLP, comportamiento clínico

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    ABSTRACT: Our purpose was to evaluate wound complications between patients with antepartum HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome with primary closure versus delayed closure and Pfannenstiel versus midline skin incisions. Medical records of patients with antepartum HELLP syndrome undergoing cesarean section were examined for type and timing of skin closure: Pfannenstiel versus midline skin incision and primary versus delayed closure. The immediate (before hospital discharge) and late (2-week postoperative check) wound complications were analyzed with respect to timing of wound closure and type of skin incision. A total of 104 patients were identified; 75 had a primary skin closure and 29 had a delayed closure 48 to 72 hours postoperatively. Immediate wound complications (wound infection, hematoma), occurred in 18 (26%) patients who had primary closure versus 8 (24%) who had a delayed closure, odds ratio 1.13 (95% confidence interval 0.39 to 3.27). A late wound breakdown was seen in only 1 patient with primary closure but in none with delayed closure. There were no fascial wound dehiscences. No statistical difference in wound complication was found between midline (primary, delayed) and Pfannenstiel (primary, delayed) incisions, odds ratio 0.65 (95% confidence interval 0.23 to 1.88). In women with antepartum HELLP syndrome delivered by cesarean section the frequency of wound complications is not influenced by type of skin incision or time of skin closure (primary or delayed).
    American Journal of Obstetrics and Gynecology 11/1996; 175(4 Pt 1):893-6. · 3.88 Impact Factor
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    ABSTRACT: A retrospective analysis was performed to assess the fetal and maternal benefits of allowing women presenting with severe pre-eclampsia between 24 and 32 weeks to continue their pregnancy following treatment of their hypertension. Cases presenting in Oxford (conservative management) and in Birmingham (stabilisation and early intervention) were compared. Patients were considered to require treatment when their systolic blood pressure was > or = 170 mmHg systolic or > or = 110 mmHg diastolic, associated with at least 1+ proteinuria and hyperuricaemia. We compared gestation at delivery, birth weight and neonatal complications for each group, and any maternal morbidity. There were 28 patients in each group. Gestational age at delivery was significantly less in the group managed by early intervention. Those women managed conservatively gained a mean of 9.5 days (range 2-26 days; P < 0.05), and their birthweight was significantly greater (P < 0.05). There was a significant difference between the length of stay in the neonatal intensive care unit between the 2 groups (P < 0.05), the babies of those women managed conservatively staying a mean of 7.4 days less. There were fewer neonatal complications in those cases managed conservatively, the number of newborns with 1 or more complications in the early intervention group being 18 (64.3%), compared with 8 (28.6%) in the expectant management group (P = 0.0001). All of the women in the group managed by early intervention recovered with no severe complications. However, those women managed conservatively had a higher incidence of HELLP (2 cases) and ELLP syndrome (2 cases), 1 case requiring temporary renal dialysis.(ABSTRACT TRUNCATED AT 250 WORDS)
    European Journal of Obstetrics & Gynecology and Reproductive Biology 11/1993; 51(3):175-80. · 1.84 Impact Factor
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    ABSTRACT: Our objective was to describe the hepatic imaging findings in selected patients with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) and to correlate these findings with the severity of concurrent clinical and laboratory abnormalities. Patients with laboratory criteria for HELLP syndrome with complaints of severe right upper quadrant abdominal pain in association with either shoulder pain, neck pain, or relapsing hypotension underwent imaging of the liver. Clinical and laboratory parameters were then correlated with the hepatic imaging findings. Thirty-four patients were evaluated in this study. Computed tomographic scanning of the liver was used for 33 patients. Additional imaging evaluations included magnetic resonance imaging for 4 patients and ultrasonographic evaluation of the liver for 5 patients. In 15 cases (45%) the computed tomographic results were abnormal. The most frequent abnormal hepatic imaging findings were subcapsular hematoma (n = 13) and intraparenchymal hemorrhage (n = 6). There was no statistically significant correlation between the presence of an abnormal hepatic imaging finding and the severity of liver function test abnormalities. However, the severity of thrombocytopenia did correlate with hepatic imaging findings (p = 0.04). In particular, an abnormal hepatic imaging finding was noted for 10 of 13 patients (77%) with a platelet count of < or = 20 x 10(9)/L (p = 0.012). Abnormalities in liver function test results do not accurately reflect the presence of abnormal hepatic imaging findings in HELLP syndrome. Patients with HELLP syndrome having complaints of right upper quadrant pain and neck pain, shoulder pain, or relapsing hypotension should undergo imaging of the liver.
    American Journal of Obstetrics and Gynecology 06/1996; 174(6):1820-5; discussion 1825-7. · 3.88 Impact Factor

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