Wayhs Sâmia Yasin, Wottrich Joise, Uggeri Douglas Prestes, Dias Fernando Suparregui
Adult Intensive Care Unit, Hospital de Caridade de Ijuí- HCI - Ijuí RS, Brazil.
Rev Bras Ter Intensiva. 2013 Apr-Jun;25(2):175-80. doi: 10.5935/0103-507X.20130030.
Preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low-platelet count), and acute fatty liver of pregnancy are the main causes of thrombotic microangiopathy and evere liver dysfunction during pregnancy and represent different manifestations of the same pathological continuum. The case of a 35-week pregnant woman who was admitted to an intensive care unit immediately after a Cesarean section due to fetal death and the presence of nausea, vomiting, and jaundice is reported. Postpartum preeclampsia and acute fatty liver of pregnancy were diagnosed. The patient developed an acute subdural hematoma and an intracerebral hemorrhage, which were subjected to neurosurgical treatment. The patient died from refractory hemolytic anemia and spontaneous bleeding of multiple organs. Preeclampsia HELLP syndrome, and acute fatty liver of pregnancy might overlap and be associated with potentially fatal complications, including intracranial hemorrhage, as in the present case. Early detection and diagnosis are crucial to ensure management and treatment success.
子痫前期、HELLP综合征（溶血、肝酶升高和血小板减少）以及妊娠急性脂肪肝是妊娠期血栓性微血管病和严重肝功能障碍的主要原因，代表了同一病理连续体的不同表现形式。本文报告了一例35周孕妇的病例，该孕妇因胎儿死亡以及出现恶心、呕吐和黄疸，在剖宫产术后立即被收入重症监护病房。诊断为产后子痫前期和妊娠急性脂肪肝。该患者发生了急性硬膜下血肿和脑出血，并接受了神经外科治疗。患者死于难治性溶血性贫血和多器官自发性出血。子痫前期、HELLP综合征和妊娠急性脂肪肝可能相互重叠，并伴有包括颅内出血在内的潜在致命并发症，如本病例所示。早期发现和诊断对于确保治疗和管理的成功至关重要。
