دورية أكاديمية
أعرض في EDS

Differentiating and Managing Rare Thrombotic Microangiopathies During Pregnancy and Postpartum.

التفاصيل البيبلوغرافية
العنوان: Differentiating and Managing Rare Thrombotic Microangiopathies During Pregnancy and Postpartum.
المؤلفون: Lim MY; Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, and the Department of Obstetrics and Gynecology, University of Utah and Intermountain Healthcare, Salt Lake City, Utah., Abou-Ismail MY, Branch DW
المصدر: Obstetrics and gynecology [Obstet Gynecol] 2023 Jan 01; Vol. 141 (1), pp. 85-108. Date of Electronic Publication: 2022 Dec 02.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0401101 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-233X (Electronic) Linking ISSN: 00297844 NLM ISO Abbreviation: Obstet Gynecol Subsets: MEDLINE
أسماء مطبوعة: Publication: 2004- : Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: New York.
مواضيع طبية MeSH: Pre-Eclampsia* , Thrombotic Microangiopathies*/diagnosis , Thrombotic Microangiopathies*/etiology , Thrombotic Microangiopathies*/therapy , Purpura, Thrombotic Thrombocytopenic*/diagnosis , Purpura, Thrombotic Thrombocytopenic*/therapy , Hemolytic-Uremic Syndrome*/diagnosis , HELLP Syndrome*/diagnosis , HELLP Syndrome*/therapy, Pregnancy ; Female ; Humans ; Postpartum Period
مستخلص: The most common thrombotic microangiopathy (TMA) of pregnancy is the well-recognized syndrome of preeclampsia with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. However, rare TMAs, including thrombotic thrombocytopenic purpura, complement-mediated hemolytic-uremic syndrome, and catastrophic antiphospholipid syndrome, may occur during pregnancy or postpartum and present with features similar to those of preeclampsia with severe features. Early recognition and treatment of these infrequently encountered conditions are key for avoiding serious maternal morbidities with long-term sequelae and possible maternal or fetal death. Differentiating between preeclampsia with severe features and these rare TMAs is diagnostically challenging as there is significant overlap in their clinical and laboratory presentation. Given the rarity of these TMAs, high-quality evidence-based recommendations on diagnosis and management during pregnancy are lacking. Using current objective information and recommendations from working groups, this report provides practical clinical approaches to diagnose and manage these rare TMAs. This report also discusses how to manage individuals with a history of these rare TMAs who are planning to conceive. To optimize favorable outcomes, a multidisciplinary approach including obstetricians, maternal-fetal medicine specialists, hematologists, and nephrologists alongside close clinical and laboratory monitoring is vital.
Competing Interests: Financial Disclosure Ming Yeong Lim received payment for participation in advisory boards from Takeda, Dova Pharmaceuticals, and Forma Therapeutics. D. Ware Branch received payment as a Member of the UCB Women with Inflammatory Disease Advisory Board in September of 2020. He received payment for Grand Rounds at the University of Iowa (Obstetric antiphospholipid syndrome: A tale of two patients. October 27, 2020). He also received payment for Obstetric antiphospholipid syndrome: Diagnosis, treatment, controversies. American Society for Clinical Laboratory Service Region VIII Annual Seminar, October 20, 2020. Dr. Branch also disclosed receiving payment for the following: Swanson, Martin & Bell, medical expert consultancy, check issued September 21, 2020; Association of Idaho Rheumatologists, Obstetric antiphospholipid syndrome. December 4, 2021; Bendin Sumrall & Ladner medical expert consultancy; Michigan Professional Insurance Exchange medical expert consultancy; Grand Rounds, Cornell University/Hospital for Special Surgery Division of Rheumatology, Obstetric antiphospholipid syndrome: A tale of three patients, May 26, 2021; Bendin Sumrall & Ladner medical expert consultancy; Gershon, Willoughby & Getz medical expert consultancy; Snow, Christensen & Matineau medical expert consultancy; Grand Rounds, Cornell University/Hospital for Special Surgery Division of Rheumatology, Obstetric antiphospholipid syndrome: A tale of three patients, May 26, 2021; Grand Rounds, University of New York, Stonybrook, November 3, 2021. Mouhamed Yazan Abou-Ismail did not report any potential conflicts of interest.
(Copyright © 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)
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تواريخ الأحداث: Date Created: 20221201 Date Completed: 20230130 Latest Revision: 20230204
رمز التحديث: 20230205
DOI: 10.1097/AOG.0000000000005024
PMID: 36455925
قاعدة البيانات: MEDLINE
الوصف
تدمد:1873-233X
DOI:10.1097/AOG.0000000000005024