Risk factors and outcome of pregnant women with thrombotic microangioapthy in Ain Shams University Maternity Hospital within 5 years duration

Abstract

There are many obstetric, medical, and surgical disorders that share many of the clinical and laboratory findings of patients with severe pre-eclampsia–eclampsia. Imitators of severe pre-eclampsia and eclampsia are life-threatening emergencies that can develop during pregnancy or in the postpartum period. These conditions are associated with high maternal and perinatal mortalities and morbidities and survivors may face long-term sequelae. Differential diagnosis may be difficult due to the overlap of several clinical and laboratory findings of these syndrome. When dealing with differential diagnoses of preeclampsia complicated by severe HELLP syndrome, it is relatively easy to decide rapidly for AFLP, SLE and APS, but sometimes it can be difficult, almost impossible, to differentiate it from multi-organ failure linked with severe sepsis or TTP/HUS due to TMA. The current study is a retrospective case series study for pregnant women with thrombotic microangiopathy in Ain Shams University Maternity Hospital in 5years duration from 2014 to 2018. The study revealed that HELLP syndrome was the most common type with 84.2% of the total thrombotic microangiopathy cases as mentioned. Thrombotic microangioapthy types showed non-significant change in its relative frequency throughout study years. The mean age of our study group was 30.5 years, mean GA was 33.5 weeks and the most frequent clinical manifestation was jaundice. Fever and CNS manfestations were significantly highest in TTP. Maternal Age was significantly highest in TTP& AFL and lowet in HELLP& undiagnosed. Gestational age was significantly highest in TTP& AFL and lowest in HELLP& undiagnosed. No Significant differences between microangioapthy types regarding parity, HTN and DM. Regarding the clinical picture Jaundice was significantly highest in AFL. Vomiting and abdominal pain were significantly highest in HUS. Blood pressure was significantly highest in HELLP and undiagnosed. As regards the laboratory findings Platelets, hemoglobin and LDH were significantly lower in TTP. AST and ALT were significantly highest in AFL. Creatinine was significantly highest in HUS. Proteinuria was significantly most frequent in HELLP.