2.
• Name: FATMA FATH ALLAH
• Age : 25years old
• From el GAMALEYA
• Married
• No Child
Personal History
3.
No medical history not HTN nor DM
No surgical history
No special habits
Past history
4.
Patient presented by :
• Dyspnea ,Tachypnea ,Pale and easy fatigability
• BP=150/100 HR=110 RBS=83
• CHEST Bilateral basal crepitation
• Abdomen lax and audible intestinal sound
• Uterus contracted and 2 drains inserted at left
• She was pregnant at 36 weeks and went to her doctor
by acute abdominal pain and accidental vaginal
bleeding
Present history
5.
• This is the first gestational urgent cesarean section
done and fetus died
• After labor BP=180/100 an uric for 12hrs
• She received 2cm Lasix, Epilate S.L, Ringer and
Glucose 10%
• Attack of fits admitted in ICU at 8/1/2018
Present history
7.
Liver and Spleen :average size
U.B: Not visualized
Both kidneys: average size,shape,increase
echogenicity grade II Nephropathy with poor C.M.D
and No back pressure
G.B: multiple stones
Free fluid is seen at Douglas pouch at pelvic region
Uterus: Bulky hyper echoic foci mainly Hage
For CT Pavli abdominal
Abdominal U.S.
8.
RIGHT KIDNEY:
• Normal size, shape, and position of the right kidney
• Normal parenchymal thickness.
• Normal palvi-calyceal system. No detected stone .
• Normal course and caliber of the right ureter . No detected
stone
LIFT KIDNEY :
• Normal size, shape, and position of the lift kidney .
• Normal parenchymal thickness.
• Normal palvi-calyceal system. No detected stone .
• Normal course and caliber of the lift ureter . No detected stone
NON-CONTRAST MULTISLICE CT
SCAN OF THE URINARY TRACT
REVEALED :
9.
Empty urinary bladder show the ballon of
folly catheter inside:
• Bulky post-partum uterus
• Bilateral minimal pleural effusion
Conclusion:
Normal CT scan of the urinary system.
URINARY BLADDER:
10.
HELLP Syndrome with AKI for:
1. Fluid chart
2. Daily lab & blood ,urine cultures and analysis
3. Blood transfusion
4. If patient still an uric and S.cr rising for dialysis
5. Renal biopsy &CT abdomen and pelvic
First Diagnosis &Plan
11.
Levofloxacin 500iv/48h
Cefipem 1gm iv/24h
NaHCO3 cap /8h
Alkapress 5mg tab /24
Calcimat tab 2x3
Dexamethazon ½ amp iv /12h
Zantac amp iv /12h
Saline 500mg /12h
Lasix iv 1ml /houre
Liver support
Vit k IM /24h
Kapron amp /12h
Patient received 3 session of dialysis
Treatment
16.
What is HELLP Syndrome?
The name HELLP stands for:
H- hemolysis ( breakdown of red blood cells)
EL- elevated liver enzymes (liver function)
LP- low platelets counts (platelets help
the blood clot)
What is HELLP Syndrome?
17.
How HELLP Syndrome is Classified
The severity of HELLP syndrome is measured according
to the blood platelet count of the mother and divided into
three categories, according to a system called "the
Mississippi classification."
Class I (severe thrombocytopenia): platelets under
50,000/mm3
Class II (moderate thrombocytopenia): platelets between
50,000 and 100,000/mm3
Class III (AST > 40 IU/L, mild thrombocytopenia):
platelets between 100,000 and 150,000/mm3
How HELLP Syndrome is
Classified
18.
The most common symptoms of HELLP
syndrome include:
Headaches
Nausea and vomiting that continue to get
worse–(This may also feel like a serious case
of the flu).
Upper right abdominal pain or tenderness
Fatigue or malaise
What are the Symptoms of
HELLP Syndrome?
20.
Because the symptoms of HELP can mimic many other
conditions or complications, it is encouraged that
physicians run a series of blood tests, including liver
function, on any woman experiencing symptoms during
the third trimester of pregnancy. HELLP syndrome may
occur before the third trimester but it is rare. It also may
occur within 48 hours of delivery, although symptoms may
take up to 7 days to be evident.
Blood pressure measurements and urine tests to check for
protein are often monitored when diagnosing HELLP
syndrome.
How is HELLP Syndrome
Diagnosed?
22.
Placental Abruption
Pulmonary Edema ( fluid buildup in the lungs)
Diseminated intravascular coagulation (DIC—blood
clotting problems that result in hemorrhage)
Adult Respiratory distress syndrome (lung failure)
Ruptured liver hematoma
Acute renal failure
Intrauterine Growth restriction (IUGR)
Infant respiratory Distress syndrome (lung failure)
Blood transfusion
What are the Risks and Complications of
HELLP Syndrome?
23.
The maternal mortality rate is about
1.1% with HELLP syndrome. The infant
morbidity and mortality rate is
anywhere from 10-60% depending on
many factors such as gestation of
pregnancy, severity of symptoms, and
the promptness of treatment.
What are the Risks and Complications of
HELLP Syndrome?