الفهرس 
Obstetric ICU AdmissionsOnly 14 pages are availabe for public view
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Abstract
: Microangiopathic hemolytic anemia (MAHA) is now used to designate any hemolytic anemia related to RBC fragmentation, occurring in association with small vessel disease. The term “thrombotic microangiopathy (TMA)” is also used to describe syndromes characterized by MAHA, thrombocytopenia, and thrombotic lesions in small blood vessels. The current study will investigate characteristics of patients admitted to obstetric ICU for microangiopathic hemolytic anemia (MAHA) variants. It will assess the indications for admission of obstetric patients in the antenatal and postpartum period due to MAHA variants and describe the profile and fetomaternal outcomes of such patients.
Objective: to review all obstetric admissions to ICU over 5-years period due to thrombotic microangiopathies which compromise SPET, HELLP, HUS, AFLP, TTP to analyze the frequency, clinical characteristics, (including ante or post natal, mode of delivery, pre-existing obstetric and medical problems), interventions, treatment given maternal and neonatal outcome, at Ain Shams University Maternity Hospital.
Patients and Methods: Type of Study: Retrospective study. Study Setting: The study was conducted at Ain Shams University Maternity Hospital, Obstetrics ICU. Study Population: The study population comprises all women admitted to obstetric ICU at Ain Shams University Maternity Hospital, during the last 5 year, with MAHA variants including SPET, HELLP, TTP, AFLP, HUS.
Results: The mean neonatal weight was 2.35 ± 0.82, and the incidence of IUGR, according to our records, was 2.7%. Neonatal weight was significantly low among patients with AFLP. Maternal death occurred in 28 cases (4.7%), 8 (7.2%) of them were HELLP syndrome, 4 cases (0.6%) were HUS, 4 cases (0.6%) were undiagnosed cases, 4 cases (0.6%) were AFLP, 4 cases were SPET, 4 cases were Eclampsia. The main causes of death were multi-organ dysfunction, pulmonary emboli, DIC, Cerebral haemorrhage and stroke. Regarding the incidence of complications in our study there were 12 cases (2%) complicated by eclampsia, 28 cases (4.7%) complicated by accidental hemorrhage and 8 cases (1.3%) complicated by renal failure. The incidence of antepartum Hge was higher among patients with HUS-TTP than patients with PE-Eclampsia-HELLP by 33% for HUS-TTP versus 3.5% for PE-Eclampsia-HELLP. This means that pregnant patients with TTP-HUS had a greater risk of maternal complications than PE-Eclampsia-HELLP.
Conclusion: Thrombotic microangiopathies during pregnancy can hardly be differentiated from case of HELLP$, AFLP and ICP. These disorders should be considered a continuum and a spectrum of a single disorder. Early termination of pregnancy with the start of plasma exchange, pulsed steroid therapy and plasmapharesis can result in marked reduction of maternal mortality in such cases