Analysis of severe preeclampsia with HELLP syndrome and hepatic subcapsular hematoma
Objective To explore the clinical manifestations,diagnosis and treatment of patients with severe preeclampsia with HELLP syndrome and hepatic subcapsular hematoma.Methods Three cases of severe preeclampsia with HELLP syndrome and hepatic subcapsular hematoma diagnosed and treated in the Department of Obstetrics of Suzhou Municipal Hospital from January 2014 to August 2023 were retrospectively analyzed,and the clinical features,treatment experience and prognosis were summarized.Results Among the 3 patients,case 1 was admitted to the hospital due to severe preeclampsia.No obvious abnormality was found in B-ultrasound on admission.One female and one male were successfully delivered by cesarean section,and she was accompanied by partial HELLP syndrome after operation.Repeated B-ultrasound and enhanced CT both suggested hepatic subcapsular hematoma.Because there were no indications for interventional or surgical treatment,conservative treatment was the main treatment,and the hematoma has absorbed since follow-up.Case 2 was diagnosed with severe preeclampsia complicated with hepatic subcapsular hematoma rupture before and during operation in another hospital,and was transferred to our hospital with persistent high fever.The admission examination results suggested that she was accompanied by complete HELLP syndrome.Culture of peritoneal drainage fluid indicated Staphylococcus aureus infection.After active anti-infection treatment,the condition improved,and the hematoma has been absorbed since follow-up.Case 3 was admitted to the hospital with vaginal bleeding and fluid,sudden lower abdominal pain,and delivered a dead baby on admission.Related examinations after surgery were completed,and severe preeclampsia associated with complete HELLP syndrome was diagnosed.Severe renal damage accompanied by intra-abdominal hemorrhage,enhanced CT showed hepatic subcapsular hematoma.After conservative treatment failed,surgical treatment was performed immediately,and the patient was transferred to ICU for active treatment after operation.At present,the local hospital is continuing to treat,and the follow-up is generally good.Conclusions Severe preeclampsia with HELLP syndrome combined with hepatic subcapsular hematoma is rare,and the clinical manifestations are diverse.It is necessary to closely observe the general condition of the patients,dynamically monitor the changes in blood pressure and key laboratory indicators,and B-ultrasound and enhanced CT are helpful for the diagnosis.The choice of treatment plan needs to be comprehensively formulated based on the individual situation of the patient,correct and appropriate treatment can effectively reduce the risk and improve the prognosis.
severe preeclampsiaHELLP syndromehepatic subcapsular hematoma
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