Publication: Preeclampsia and Hellp syndrome at 20 weeks' gestation associated with the antiphospholipid syndrome
Abstract
Preeklampsi, genellikle bir üçüncü trimester hastalığı olup hidatidiform mol veya molar dejenerasyon vakaları dışında nadiren 20. gebelik haftasından önce görülür. Bizim vakamız 34 Yaşında gravida 4 para 2 bir gebe 20. Gebelik haftasında şiddetli preeklampsi ve HELLP sendromu ön tanıları ile refere edildi. Gelişte hastanın klinik ve laboratuar bulguları şiddetli preeklampsi, hemoliz, trombositopeni, uzamış aPTT ve normal hepatik transarriinaz enzim varlığını ortaya koydu.Immunoassay sonucunda lupus antikoagulant, antikardiolipin, antiplatelet ve antifosfolipid IgG antikorları kuvvetli pozitif bulundu. Antihipertansif-antikoagulan tedavi başlanan ve hospitalizasyon boyunca TA düzeyleri antihipertansif medikasyonlara refrakter seyreden hastada 4. gün ani epigastrik ağrı gelişti ve eş zamanlı karaciğer transaminaz enzim düzeyleri belirgin artış gösterdi. Aynı gün magnezyum infüzyonu başlanan hastada fetal kalp atımları alınamadı. Fetal ölüm sonografi ile konfirme edildi ve gebelik vajinal prostogiandin tablet uygulaması ile sonlandırıldı. Gebeliğin terminasyonunu takiben hipertansiyon, proteinüri ve karaciğer enzim düzeyleri dramatik düzelme gösterdi. Hasta postpartum dönemde normotensif olup düşük doz aspirin tedavisi altındadır. Antifosfolipid olguları erken gebelik döneminde preeklampsi ve HELLP sendromu ile komplike olabilir. Erken gestasyonel haftalarda preeklampsi ve HELLP sendromu varlığı obstetrisyen için olası bir antifosfolipid sendromu açısından uyarıcı olmalı ve bu hastalarda gebeliğin ivedilikle termine edilmesinin gelecek katastrofik olayları önlemede belkide tek terapötik opsiyon olduğu hatırlanmalıdır.
Preeclampsia is usually a third trimester disease of pregnancy that rarely occurs before 20 weeks of gestation except for cases of hydatidiform mole or molar degeneration. Preeclampsia and HELLP syndrome presenting at or before 20 weeks' gestation have been rarely mentioned in literature, in or case, a 34 year-old pregnant woman gravida 4 para 2 presented severe preeclampsia and HELLP syndrome at 20 weeks' gestation. Admission clinical and laboratory findings demostrated severe preeclampsia, hemolysis, low platelets and normal liver enzymes with a prolonged aPTT. Further laboratory workup with immunoassay detected high titers of lupus anticoagulant, anticardiolipin, antiplatelet and antiphospholipid IgG antibodies.Antihypertensive-anticoagulant therapy then was employed.The observed elevations in the. liver enzymes coincided with an abrupt onset of epigastric pain which developed on day four. Then magnesium infusion was instituted and fetal death was confirmed by ultrasonography. Termination of pregnancy has led to prompt resolution of clinical and laboratory findings of preeclampsia and HELLP syndrome. The patient has been maintained on low dose aspirin and is now normotensive during postpartum period. a we conclude that pregnancy with the antiphospholipid syndrome can be complicated by preeclampsia and HELLP syndrome at early weeks of gestation and that these findings should alert an obstetrician for suspicion of antiphospholipid syndrome.
Preeclampsia is usually a third trimester disease of pregnancy that rarely occurs before 20 weeks of gestation except for cases of hydatidiform mole or molar degeneration. Preeclampsia and HELLP syndrome presenting at or before 20 weeks' gestation have been rarely mentioned in literature, in or case, a 34 year-old pregnant woman gravida 4 para 2 presented severe preeclampsia and HELLP syndrome at 20 weeks' gestation. Admission clinical and laboratory findings demostrated severe preeclampsia, hemolysis, low platelets and normal liver enzymes with a prolonged aPTT. Further laboratory workup with immunoassay detected high titers of lupus anticoagulant, anticardiolipin, antiplatelet and antiphospholipid IgG antibodies.Antihypertensive-anticoagulant therapy then was employed.The observed elevations in the. liver enzymes coincided with an abrupt onset of epigastric pain which developed on day four. Then magnesium infusion was instituted and fetal death was confirmed by ultrasonography. Termination of pregnancy has led to prompt resolution of clinical and laboratory findings of preeclampsia and HELLP syndrome. The patient has been maintained on low dose aspirin and is now normotensive during postpartum period. a we conclude that pregnancy with the antiphospholipid syndrome can be complicated by preeclampsia and HELLP syndrome at early weeks of gestation and that these findings should alert an obstetrician for suspicion of antiphospholipid syndrome.