Severe preeclampsia and HELLP syndrome at 18 weeks gestation

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Abstract

Background: According to the current Russian and international clinical guidelines, preeclampsia is a complication of pregnancy, childbirth and postpartum period characterized by an increase in systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg after 20 weeks gestation, regardless of the BP level in the patient’s history, combined with proteinuria or at least another parameter indicating the onset of multi-organ failure. However, preeclampsia is generally known to occur before 20 weeks gestation in patients with molar pregnancy.

Case report: The article presents a clinical observation of a case of severe preeclampsia complicated by HELLP syndrome at 18 weeks gestation in a healthy patient at high risk of developing preeclampsia who did not receive acetylsalicylic acid prophylaxis. The clinical case has a favorable outcome for the mother but it resulted in the fetal loss.

Conclusion: It is recommended to determine biochemical markers (PlGF or PlGF/sFlt-1 ratio) in order to improve the efficiency of prenatal screening and to identify the risk group for the development of preeclampsia before 20 weeks gestation. The effects of acetylsalicylic acid on the prevention of preeclampsia before 20 weeks gestation have not been studied yet due to the rare incidence of atypical course of this complication. It is necessary to conduct international registry studies to establish new criteria for the prognosis of early-onset preeclampsia and to reconsider the current definition.

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About the authors

Tatiana E. Belokrinitskaya

Chita State Medical Academy, Ministry of Health of Russia

Author for correspondence.
Email: tanbell24@mail.ru
ORCID iD: 0000-0002-5447-4223

Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology of Pediatric Faculty and Faculty of Professional Retraining

Russian Federation, Chita

Nataly I. Frolova

Chita State Medical Academy, Ministry of Health of Russia

Email: taasyaa@mail.ru
ORCID iD: 0000-0002-7433-6012

Dr. Med. Sci., Associate Professor at the Department of Obstetrics and Gynecology of Pediatric Faculty and Faculty of Professional Retraining

Russian Federation, Chita

Daria S. Kargina

Transbaikal Regional Hospital, Chita

Email: gven2007@yandex.ru
ORCID iD: 0000-0003-0130-5861

obstetrician-gynaecologist at the Gynecology Department

Russian Federation, Chita

Anastasiya O. Zolotukhina

Transbaikal Regional Pathoanatomical Bureau

Email: zolot-anastasiya@mail.ru
ORCID iD: 0000-0002-1136-1798

Head of the Department of Pediatric and Prenatal Pathology

Russian Federation, Chita

Maria A. Agarkova

Chita State Medical Academy, Ministry of Health of Russia

Email: rinary_19@mail.ru
ORCID iD: 0009-0005-4924-1475

Resident at the Department of Obstetrics and Gynecology of Pediatric Faculty and Faculty of Professional Retraining

Russian Federation, Chita

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Supplementary files

Supplementary Files
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1. JATS XML
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2. Fig. 1. Fibrinoid deposition and areas of narrowing of the intervillous space, fields of villous infarctions (hematoxylin and eosin staining, ×200)

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3. Fig. 2. Premature maturation of the villous tree (hematoxylin and eosin staining, ×200)

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4. Рис. 3. Гиперплазия синтиальных узелков (окраска гематоксилин-эозин, ×200)

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5. Fig. 4. Hypercapillarization of villi (hematoxylin and eosin staining, ×400)

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6. Fig. 5. Chorangiosis of the villi (increased number of capillaries in the terminal villi of the placenta) (hematoxylin and eosin staining, ×200)

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