Search Results (69)

Background and Objectives: Thrombocytopenia complicates 6.6–11.6% of pregnancies. While gestational thrombocytopenia (GT) is usually benign, etiologies such as immune thrombocytopenia (ITP), preeclampsia, and HELLP syndrome require individualized management. This study aimed to characterize the etiological spectrum, maternal peripartum hematologic outcomes, blood product utilization, and mode of delivery in a tertiary-center cohort of thrombocytopenic pregnancies and to assess whether platelet count should influence delivery mode decisions. Materials and Methods: This retrospective cohort study included 137 thrombocytopenic pregnant women at a tertiary center (2010–2019), categorized by etiology and severity. Peripartum hemoglobin, hematocrit, and platelet counts were compared between delivery groups. Blood product utilization was recorded and analyzed using t-test, ANOVA, chi-square, Fisher’s exact, and Fisher–Freeman–Halton tests; binary logistic regression was used for multivariable analysis. Results: GT (43.1%) and ITP (32.1%) were the most prevalent diagnoses; cesarean delivery rate was 52.6%. Postpartum Hb was higher in the vaginal delivery group (10.24 ± 1.28 vs. 9.80 ± 1.26 g/dL; p = 0.003), while platelet counts were paradoxically lower (p = 0.039). Platelet transfusion rates did not differ significantly between delivery modes (23.1% vs. 27.8%; p = 0.621). Severe thrombocytopenia required platelet transfusion in 92.6% of cases versus 11.6% (moderate) and 0% (mild) (p < 0.001). RBC transfusion was highest in gestational hypertensive disease (41.2%) versus GT (5.1%) and ITP (2.3%) (p < 0.001). General anesthesia was used in 75% of cesarean cases. Conclusions: Delivery mode in thrombocytopenic pregnancies should be guided by obstetric indications, not platelet count alone. Although postpartum platelet counts declined more steeply after vaginal delivery, this did not increase transfusion requirements. Gestational hypertensive disorders carried the greatest hemorrhagic burden, highlighting the need for etiology-specific multidisciplinary planning. The high general anesthesia rate warrants prospective institutional audit of anesthetic decision-making protocols to determine adherence to current neuraxial anesthesia thresholds. This study is limited to maternal peripartum hematologic outcomes; neonatal outcomes were not captured and should be addressed in future prospective research. Full article

Thrombocytopenia affects up to 10% of pregnant women and represents the second most common blood disorder during pregnancy. Its causes include immune-mediated thrombocytopenia, hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome, preeclampsia (PE), and benign pregnant thrombocytopenia. Diagnosis is crucial because the cause dictates the effect on maternal health, pregnancy management, and neonatal outcomes. This narrative review examines the range of thrombocytopenia during pregnancy, primarily focusing on diagnostic evaluation, underlying pathophysiological causes, and differential diagnosis. In addition, it organizes maternal and fetal complications that might be caused by the condition, such as bleeding, preterm birth, and neonatal thrombocytopenia. Moreover, current patient management based on available evidence and clinical practice is discussed, including immunomodulatory therapies, platelet transfusions, clinical monitoring, and supportive care. A thorough and clinically guided approach to thrombocytopenia in pregnancy is indispensable for maximizing maternal and fetal outcomes and facilitating the personalization of perinatal care. Full article

Preeclampsia is a heterogeneous disorder affecting approximately 2–5% of pregnancies and remains a major cause of maternal and perinatal morbidity and mortality worldwide. Its clinical presentation ranges from mild, nearly asymptomatic forms to severe conditions progressing to eclampsia or HELLP syndrome. Despite significant advances in understanding its pathophysiology, preeclampsia continues to pose diagnostic and therapeutic challenges. In recent years, intensive research efforts have focused on developing comprehensive diagnostic criteria, identifying novel biomarkers, improving risk prediction models, and establishing effective preventive and monitoring strategies. However, expert opinions and clinical guidelines remain partially inconsistent. This review aims to summarize current global concepts regarding the epidemiology, pathophysiology, risk stratification, diagnosis, prevention, and monitoring of preeclampsia, with particular emphasis on emerging biomarkers and personalized approaches to patient care. Full article

Background: Thrombotic thrombocytopenic purpura (TTP) is a rare but life-threatening thrombotic microangiopathy (TMA) caused by severe deficiency of the von Willebrand factor–cleaving protease ADAMTS13. Pregnancy is a recognized trigger for both immune-mediated and congenital TTP and is associated with increased maternal and fetal morbidity. Clinical overlap with other pregnancy-associated TMAs, including preeclampsia and Hemolysis, Elevated Liver enzymes, and Low Platelet count (HELLP) syndrome, often delays diagnosis. This review synthesizes current evidence on pathophysiology, diagnostic uncertainty, and gestation-specific management of pregnancy-associated TTP, highlighting differences between immune-mediated and congenital disease. Methods: This is a narrative review. We performed a targeted literature search of PubMed/MEDLINE (from inception to December 2025) to identify English-language publications. The study types included were case reports/series, observational studies, large database studies, randomized trials, reviews, and relevant guidelines addressing TMA in pregnancy, with emphasis on immune-mediated and congenital TTP. Search terms included “pregnancy”, “thrombotic thrombocytopenic purpura”, “hereditary TTP”, “acquired TTP”, “ADAMTS13,” “thrombotic microangiopathy,” “HELLP,” “postpartum”, and “complement-mediated TMA” alone or in combination. The search was supplemented by manual screening of reference lists and key guidelines. Articles were selected based on relevance to diagnosis and management of pregnancy-associated TTP. Conference abstracts and non-peer-reviewed sources were not routinely included and were considered only when peer-reviewed evidence was limited. Results: Pregnancy-associated TTP remains a major diagnostic challenge due to overlapping clinical and laboratory features with other obstetric thrombotic microangiopathies. Distinguishing immune-mediated from congenital TTP is essential, as management and prognosis differ substantially. Prompt recognition and early initiation of therapeutic plasma exchange, immunosuppression, or prophylactic plasma therapy markedly improve maternal outcomes. Rapid ADAMTS13 testing, structured risk stratification, and multidisciplinary care are central to optimal management. Fetal outcomes are closely linked to gestational age at onset and timeliness of therapy. Conclusions: Early differentiation of TTP from other pregnancy-associated TMAs is critical for maternal and fetal survival. Advances in rapid ADAMTS13 diagnostics and emerging targeted therapies, including caplacizumab and recombinant ADAMTS13, offer opportunities to improve precision management and outcomes in future pregnancies. Full article

Placental abruption (PA) without vaginal bleeding is known to be associated with severe outcomes when compared to symptomatic cases; the presence of hypertensive disorders of pregnancy (HDP) is an additional negative prognostic factor. According to guidelines, severe HDP are indications for prompt delivery after maternal–fetal stabilization. Considering gestational age, parity and clinical obstetric examination, the induction of labor should be prioritized to avoid additional risks associated with cesarean section. However, since only a minority of cases of PA may be detected by ultrasonography (US), findings consistent with this suspicion should contribute to the establishment of an appropriate mode of delivery. We present two cases affected by severe HDP, eclampsia and HELLP syndrome, admitted to St. Luke Catholic Hospital, Wolisso, Ethiopia. In both cases, obstetric point-of-care (POC) US revealed a live premature fetus and a solid heterogeneous placental mass, raising the suspicion of concealed placental abruption. To expedite delivery, cesarean section was promptly offered. PA was confirmed in both cases; the first had stillbirth and postpartum hemorrhage, while the second ended up with healthy mother and newborn. In conclusion, POC-US imaging could play a role in optimizing delivery mode and timing for patients with HDP in low-resourced settings. Additional research is warranted to determine the impact of this technique in the management of obstetric emergencies. Full article

Introduction: Both preeclampsia (PE) and prediabetes (PD) are known hypertensive disorders of pregnancy, and a correlation has been shown between these two diseases. A recent study in our laboratory has shown that pregestational PD is a risk factor for developing PE during pregnancy, as pregestational PD increased antiangiogenic factors. However, pregestational PD antiangiogenic release has not been shown to be associated with liver dysfunction. Therefore, this study seeks to investigate pregestational PD as a risk factor for hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome. Materials and Methods: Animals were divided into a normal pregnant group (ND), a preeclamptic pregnant group (PE), and a prediabetic pregnant group (PD). On gestational day (GND) 19, animals were sacrificed, and blood and liver tissues were collected to measure antioxidant protection and lipid peroxidation parameters, liver TGs, liver enzymes, TNF-α, IL-6, and hematology parameters. Results: The results showed significant increases in liver TGs, liver enzymes, TNF-α, IL-6, and hematology parameters in the PE and PD pregnant groups compared to the ND group. Conclusions: These findings suggest that pregestational PD predisposes patients to metabolic and inflammatory changes associated with HELLP syndrome. To our knowledge, this is the first study to demonstrate a link between pregestational PD and HELLP syndrome-related complications in a preclinical model, highlighting the importance of monitoring metabolic health before pregnancy. Full article

Background/Objectives: Severe thrombocytopenia (platelet count ≤ 50,000/µL) is a diagnostically heterogeneous condition during pregnancy, encompassing obstetric and non-obstetric etiologies that require distinct management approaches. The aims of this study were to determine the etiological distribution of severe thrombocytopenia during pregnancy and to evaluate its management strategies and perinatal outcomes in a tertiary perinatology center. Methods: This retrospective cohort study included 203 pregnant women with severe thrombocytopenia (platelet count ≤ 50,000/µL) stratified into three groups: Group A (30,000 < platelet count ≤ 50,000/μL, n = 123), Group B (10,000 < platelet count ≤ 30,000/μL, n = 54), and Group C (<10,000/µL, n = 26). Demographic characteristics, etiological diagnoses, treatment modalities, and perinatal outcomes were evaluated. Results: The etiological distribution varied significantly across severity groups (p = 0.001). HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome was the most common cause overall (36.5%) and predominated in milder thrombocytopenia (Group A: 40.7%; Group B: 42.6%), whereas non-obstetric etiologies, such as immune thrombocytopenia (ITP), were significantly more frequent in Group C (57.7%). Treatment intensity increased with severity, with 79.7% of Group A requiring no intervention compared to only 26.9% of Group C (p = 0.001). Gestational age at delivery (median 37 weeks, p = 0.587) and birth weight (mean 2547 ± 968 g, p = 0.191) were comparable across severity groups. Minimum platelet count showed no significant correlation with delivery timing, birth weight, or hemoglobin decline. Conclusions: Severe thrombocytopenia in pregnancy exhibits distinct etiological patterns that vary according to platelet count severity. Favorable perinatal outcomes are achievable with appropriate diagnosis and management in specialized centers, underscoring the importance of comprehensive diagnostic evaluation rather than relying solely on platelet count thresholds for clinical decision-making. Full article

Serine protease inhibitor A3 (SERPINA3), also called α-1-antichymotrypsin, is a serine protease involved in placental dysfunction. This study examines SERPINA3 polymorphisms and haplotypes for associations with maternal hypertensive disorders of pregnancy (HDPs) and preeclampsia with severe features (sPE) or Hemolysis, Elevated Liver Enzymes, and Low Platelet (HELLP) syndrome in mother–baby dyads (HDP) and mother–father–baby triads (sPE/HELLP). This retrospective case–control study examined two patient cohorts, HDPs and severe PE/HELLP syndrome. The HDP population included cases (n = 142) and controls (n = 168) of mother–baby dyads recruited from a large, urban, safety-net hospital in Los Angeles. The sPE/HELLP syndrome population included cases (n = 189) and controls (n = 28) of mother–father–baby triads recruited through HELLP syndrome research websites. Cases were verified by medical chart abstraction when possible. Two SERPINA3 SNPs, rs4934 and rs1884082, were genotyped from saliva samples, mouthwash, or buccal swabs. The Haplin package in R was used to perform genetic association analyses. No evidence of increased risk related to individual SERPINA3 SNPs or haplotypes for the developing HDPs or sPE/HELLP was found in individual nor combined cohorts. In the HDP cohort, the g-a haplotype (relative to T-G haplotype) was borderline significant for increased risk of HDPs when carried by the child (double dose: RR = 1.58, 95% CI: (1.00, 2.52), p = 0.05). We observed significant parent-of-origin (PoO) effects in the combined cohort: specifically, an increased risk of HDPs/sPE/HELLP if the mother carries a double copy for both rs4934 (RR = 3.03, 95% CI (1.50, 6.09), p < 0.01) and rs1884082 (RR = 2.38, 95% CI (1.22, 4.71), p = 0.01). A reduced risk of HDPs/sPE/HELLP was observed for rs4934 (RR = 0.54, 95% CI (0.31, 0.98), p = 0.04) and rs1884082 (RR = 0.52, 95% CI (0.30, 0.91), p = 0.02) with child carriage of the maternally inherited allele. In contrast, child carriage of a paternally inherited copy of the variant allele for rs4934 increased risk of HDPs/sPE/HELLP (RR = 1.54, 95% CI (1.09, 2.20), p = 0.02). There was no evidence that SERPINA3 gene polymorphisms and haplotypes were associated with risk of HDPs or sPE/HELLP. However, significant PoO effects were observed in the combined cohort analysis, with child carriage of rs4934 that is maternally inherited decreasing HDPs/sPE/HELLP risk while a paternally inherited copy increases risk, suggesting a role for maternal–fetal genomic incompatibility. Full article

During pregnancy, a series of physiological changes occur in women, particularly affecting the cardiovascular system with significant hemodynamic alterations. Subsequently, this leads to renal adaptations manifesting through variations in glomerular filtration rate. This close interconnection between the heart and kidneys implies that issues arising in one organ will disrupt this fundamental balance, inevitably involving all associated organs. The purpose of this review is to gather all possible nephrological conditions that may arise during pregnancy, as well as pre-existing conditions that may become apparent or worsen during this period. This review describes the natural history, treatment, and impact of these conditions on pregnancy itself. Among the most common conditions are preeclampsia and HELLP syndrome, severe complications characterized by hypertension, proteinuria, and multiorgan damage that require immediate clinical attention. Additionally, women with chronic kidney disease are at higher risk of developing maternal–fetal complications, such as preterm birth and intrauterine growth restriction. Common causes of acute renal failure are also analyzed, including thrombotic microangiopathy, acute fatty liver of pregnancy, acute onset or flare of systemic lupus erythematosus, and catastrophic antiphospholipid antibody syndrome. Given the importance of proper renal function during pregnancy, it is essential to have a thorough understanding of nephrological diseases that may affect this phase of women’s lives. This knowledge is crucial for managing these conditions effectively to avoid risks to the survival of both the mother and the newborn. Full article

Damage control surgery (DCS) is a staged surgical strategy for rapid control of life-threatening bleeding, followed by physiological stabilization and delayed definitive repair. Abdomino-pelvic packing (APP)—placing compressive material within the pelvis and/or abdomen to tamponade bleeding—is a cornerstone of DCS as a temporizing measure to achieve hemostasis and stabilization in critically unstable patients. This narrative review synthesizes current evidence on DCS with a focus on APP—a technique historically developed in trauma and orthopedic surgery for exsanguinating pelvic bleeding but adaptable to gynecologic and obstetric emergencies. We outline the historical evolution, physiological basis, and stepwise protocol of DCS, adapted to specialty-specific conditions such as postpartum hemorrhage, placenta accreta spectrum, uterine rupture, and hepatic rupture in HELLP syndrome, as well as oncologic surgeries (debulking, exenteration, lymphadenectomy) and benign procedures (trocar-entry injuries in laparoscopy, presacral bleeding in sacrocolpopexy, and retroperitoneal hemorrhage in deep-infiltrating endometriosis). Modern adjuncts—including early tranexamic acid, topical hemostatic agents, and multidisciplinary coordination—have transformed packing from a last-resort maneuver into an integrated component of staged hemorrhage control. In OB/GYN, APP allows for successful hemostasis in 75–90% of cases, with significantly lower mortality rates than trauma surgery. In conclusion, APP as a potentially life-saving maneuver within DCS requires integration into standardized, institution-wide hemorrhage protocols in OB/GYN. Training, simulation, and guideline adoption are critical, particularly in resource-limited settings where advanced interventions for catastrophic bleeding are inaccessible. Full article

Background and Clinical Significance: Purtscher-like retinopathy is a rare occlusive microangiopathy that causes sudden vision loss of varying severity. It presents with diverse retinal findings, such as cotton-wool spots, haemorrhages, and optic disc and macular edema, among others. A key characteristic is the absence of trauma. This condition has been observed in patients with acute pancreatitis, renal failure, preeclampsia, HELLP syndrome, childbirth, and other systemic disorders. Case Presentation: A 35-year-old male presented with complaints of seeing spots in front of both eyes, with a duration of ten days following the initiation of treatment for acute alcoholic pancreatitis. On examination, best-corrected visual acuity (BCVA) in both eyes was 5/6. Fundus examination revealed multiple cotton-wool spots and haemorrhages located in the posterior pole and around the optic disc, more pronounced in the left eye, where the optic disc had blurred margins and the macular reflex was absent. Perimetry showed paracentral scotomas, and optical coherence tomography (OCT) revealed thickening and disruption of the inner retinal layers in the papillomacular region of both eyes. Fundus fluorescein angiography demonstrated adequate perfusion of the vascular network, with hypofluorescent areas in the arteriovenous phase, peripapillary and in the papillomacular zone, due to masking by cotton-wool spots and haemorrhages. Treatment included systemic antiplatelet agents, anticoagulants, and vitamins, along with topical non-steroidal anti-inflammatory drugs. Two months after the initial presentation visual acuity improved to 6/6 in both eyes. Follow-up OCT scans showed atrophy of the inner retinal layers corresponding to the previous cotton-wool spot and the areas of reduced light sensitivity on perimetry had decreased in size. Conclusions: Acute pancreatitis is the most common systemic condition associated with the development of Purtscher-like retinopathy. Timely diagnosis and management of the underlying systemic disease are essential for preventing ocular complications. Ophthalmological evaluation is necessary in patients with acute pancreatitis who present with visual symptoms in order to detect this often-overlooked rare condition. Full article

Background: Pregnancy-Related Acute kidney injury (PRAKI) is a critical complication of pregnancy, defined by the sudden deterioration in renal function during gestation or within the initial six weeks postpartum. Pregnancy is thought to increase the risk of acute kidney injury (AKI) by 51%. This is linked to the anatomical alterations that occur during pregnancy and special conditions, such as preeclampsia/eclampsia. PRAKI’s epidemiology and outcome vary between developed and developing nations. PRAKI is an uncommon entity in high-income countries; however, its incidence has recently increased. The aim of this systematic review is to evaluate the maternal and perinatal outcomes and risk factors affecting pregnancies affected by AKI. Methods: Comprehensive research was performed in PubMed/Medline, Scopus, and Google Scholar electronic databases from 2015 up to January 2025, using the terms AKI, PRAKI, sepsis, preeclampsia/eclampsia, liver enzymes, low platelet count (HELLP) syndrome, and pregnancy. After a thorough assessment, 25 full-text articles were obtained. Results: Our results revealed that preeclampsia, eclampsia, HELLP syndrome, and antepartum and postpartum hemorrhage predispose women to PRAKI. Other unusual factors, like disseminated intravascular coagulation (DIC) or hemolytic uremic syndrome (HUS), should not be underestimated. Furthermore, the latest published data showed unfavorable maternal and fetal outcomes in pregnancies affected by AKI compared to the general population. Conclusions: PRAKI constitutes a serious pregnancy complication that requires immediate treatment. The higher prevalence of PRAKI in developing countries (4–26%) versus wealthy nations (1.0–2.8%) has considerably indicated the impact of socioeconomic status and the accessibility of health services. Full article

Background and Objectives: Inherited thrombophilia (IT) increases the risk of adverse pregnancy outcomes, but the benefit of low-molecular-weight heparin (LMWH) prophylaxis remains debated. This study aimed evaluate the effect of LMWH by analyzing outcomes in women with IT who received LMWH versus those who did not and also compare pregnancy complication rates before and after inherited thrombophilia diagnosis. Materials and Methods: We conducted a retrospective case–control study including 276 pregnant women with inherited thrombophilia and prior pregnancy complications and 276 healthy pregnant controls on delivery. The main outcome was the incidence of complications: preterm rupture of membranes, oligohydramnios, fetal growth restriction, preterm delivery, stillbirth, HELLP syndrome, gestational hypertension, deep vein thrombosis, and recurrent pregnancy loss. The effect of LMWH was assessed by comparing complication rates among inherited thrombophilia patients who received therapy versus those who did not. Results: Women with IT were older, had higher BMI, delivered earlier, and had neonates with lower birth weight compared to controls. In current pregnancies, LMWH was associated with reduced rates of preterm delivery, fetal growth restriction, gestational hypertension, and recurrent pregnancy loss, especially in factor V Leiden carriers. LMWH had little effect on low-risk genotypes and was not independently associated with outcome reduction. Conclusions: LMWH prophylaxis should be reserved for high-risk women with IT. Routine use in all IT pregnancies is not justified and may cause unnecessary risks and costs. Early screening, risk stratification, and individualized care are essential to optimize outcomes. Full article

Purpose: Preeclampsia is a serious pregnancy complication without curative treatment. The central nervous system (CNS) is affected in severe cases of preeclampsia. Until now, no biomarker or other predictive method has been established for predicting severe CNS injury, including the development of eclampsia and/or long-term complications. In this systematic review, we aimed to investigate the association between maternal blood (serum or plasma) S100B levels and preeclampsia, focusing on its predictive value and correlation with the severity of the disease, with a particular focus on neurological symptoms. Methods: A search of online databases, including Medline via PubMed, Scopus databases, and Web of Science, was performed based on the PRISMA guidelines for systematic reviews. Results: Ten case–control studies that met the inclusion criteria were identified and further evaluated according to the Newcastle–Ottawa Scale (NOS). All of the studies revealed that S100B blood levels were higher in preeclampsia compared to uncomplicated pregnancies before onset, after its diagnosis, and one year postpartum. Its predictive value seems to be adequate long before the onset of preeclampsia, especially in the early third trimester. Furthermore, its levels seem to correlate with severe complications during pregnancy, such as eclampsia and HELLP syndrome, as well as neurological dysfunction postpartum. Conclusions: S100B is a promising biomarker for the prediction of acute and long-term CNS injury in preeclampsia. Still, additional studies should be conducted in order to establish a standard method of measurement and solidify its clinical use in preeclampsia management, providing individualized care in order to improve perinatal outcomes and provide personalized follow-up postpartum. Full article

Background: Pre-eclampsia is a significant hypertensive disorder affecting 2–8% of pregnancies globally, significantly contributing to maternal/perinatal deaths. Early identification of at-risk patients is crucial for reducing these mortalities, yet first-trimester screening remains inaccessible in many low-resource settings. This study aims to develop a second-trimester risk stratification model based on clinical parameters to assist in managing pre-eclampsia in diverse healthcare contexts. Methods: This retrospective cohort study analyzed medical records from 700 pregnancies (350 with preeclampsia, 350 controls) between January 2021 and August 2024 at a tertiary medical center in western Romania. Sample size was calculated to achieve 90% power with α = 0.05 for detecting clinically significant differences between groups. Data analysis focused on clinical variables such as maternal age, hypertension, diabetes, and socioeconomic factors. A scoring model was developed using logistic regression and validated for predictive accuracy using ROC curve analysis, with AUC as the primary metric. Calibration was assessed using the Hosmer–Lemeshow test. Results: The risk stratification model demonstrated an AUC of 0.91 (95% CI: 0.88–0.94), indicating high discriminative capability. The model showed good calibration (p = 0.78). Sensitivity was 74.4%, and specificity reached 97.8%. Patients were categorized into low (0–4 points), moderate (5–7 points), and high-risk (≥8 points) groups based on optimized cut-off values. High-risk patients showed significantly higher rates of adverse outcomes, including eclampsia (12.3% vs. 0% in low-risk, p < 0.001) and HELLP syndrome (8.7% vs. 0.5% in low-risk, p < 0.001). Neonates born to high-risk mothers had lower birth weight (mean difference: 486 g, p < 0.001), smaller head circumference (mean difference: 2.3 cm, p < 0.001), and lower APGAR scores (median difference: 2 points, p < 0.001). Conclusions: This novel model offers a practical second-trimester risk assessment tool that leverages routine clinical data available after 20 weeks of gestation. It facilitates targeted care and resource allocation, particularly benefiting settings lacking early screening access. Implementation of risk-stratified management protocols could significantly improve maternal and neonatal outcomes in diverse healthcare environments. Full article