Download PDF
Semin Thromb Hemost 2001; 27(2): 131-136
DOI: 10.1055/s-2001-14071
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Vasospasms Are Characteristic in Cases with Eclampsia/Preeclampsia and HELLP Syndrome: Proposal of an Angiospastic Syndrome of Pregnancy

Takao Kobayashi1 , Naoki Tokunaga1 , Haruo Isoda2 , Naohiro Kanayama1 , Toshihiko Terao1
  • 1Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan and
  • 2Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
Further Information

Publication History

Publication Date:
31 December 2001 (online)

    Permissions and Reprints

ABSTRACT

We attempted to prove the occurrence of generalized vasospasms in cases with eclampsia/preeclampsia and HELLP syndrome and to suggest the existence of an angiospastic syndrome of pregnancy. Sixteen cases with severe preeclampsia were evaluated. Among them, three cases were complicated by eclampsia and one case with HELLP syndrome. Cranial magnetic resonance angiography (MRA) was performed in 15 cases, and celiac angiography was performed in one case. Vasospasms were observed in 12 cases (75.0%), including all cases involving eclampsia and HELLP syndrome, and cerebral infarction was observed in one case. Typical vasospasms were found by MRA in the middle and posterior cerebral arteries with peripheral ischemic changes in cases with severe preeclampsia and eclampsia. Vasospasms of the hepatic arteries were observed by celiac angiography in a case with HELLP syndrome. Vasospasms are characteristic for patients with eclampsia/preeclampsia and HELLP syndrome, and the existence of an angiospastic syndrome of pregnancy is proposed.

KEYWORD

Preeclampsia - eclampsia - HELLP syndrome - vasospasms - magnetic resonance angiography (MRA)

REFERENCES

  • 1 Matsuda Y, Tomosugi T, Maeda Y. Cerebral magnetic resonance angiographic findings in severe preeclampsia.  Gynecol Obstet Invest . 1995;  40 249-252
    PubMedSearch in Google Scholar
  • 2 Kobayashi T, Terao T. Preeclampsia as chronic disseminated intravascular coagulation.  Gynecol Obstet Invest . 1987;  24 170-178
    PubMedSearch in Google Scholar
  • 3 Caritis S, Sibai B, Hauth J. Low-dose aspirin to prevent preeclampsia in women at high risk.  N Engl J Med . 1998;  339 667-671
    CrossrefPubMedSearch in Google Scholar
  • 4 Sibai B M. Treatment of hypertension in pregnant women.  N Engl J Med . 1996;  335 257-265
    CrossrefPubMedSearch in Google Scholar
  • 5 Khatun S, Kanayama N, Belayet H. Erratum to ``Increased concentrations of plasma epinephrine and norepinephrine in patients with eclampsia''.  Eur J Obstet Gynecol Reprod Biol . 1997;  74 103-109
    CrossrefPubMedSearch in Google Scholar
  • 6 Belayet H, Kanayama N, Khatun S. Decreased renal and hepatic blood flow with preeclampsia-like histologic changes was obtained by stimulation of the celiac ganglion with LPS.  Am J Perinatol . 1998;  15 109-114
    PubMedSearch in Google Scholar
  • 7 Khatun S, Kanayama N, Sato E. Eclamptic plasma stimulates norepinephrine release in cultured sympathetic nerve.  Hypertension . 1998;  31 1343-1349
    PubMedSearch in Google Scholar
  • 8 Halim A, Kanayama N, El Maradny E. Correlated plasma elastase and sera cytotoxicity in eclampsia. A possible role of endothelin-1 induced neutrophil activation in preeclampsia-eclampsia.  Am J Hypertens . 1996;  9 33-38
    CrossrefPubMedSearch in Google Scholar
  • 9 Kobayashi T, Sugimura M, Kanayama N. Coagulation/ fibrinolysis disorders in patients with severe preeclampsia.  Semin Thromb Hemost . 1999;  25 451-454
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Halim A, Kanayama N, El Maradny E. HELLP syndrome-like biochemical parameters obtained with endothelin-1 injection in rabbits.  Gynecol Obstet Invest . 1993;  35 193-198
    PubMedSearch in Google Scholar
  • 11 Halim A, Kanayama N, Maehara K. Eclampsia-like seizures and electroencephalographic changes in pregnant rabbits with endothelin-1 injection.  Gynecol Obstet Invest . 1995;  39 1-7
    PubMedSearch in Google Scholar
  • 12 Schobel H P, Fischer T, Heuszer K. Preeclampsia-a state of sympathetic overactivity.  N Engl J Med . 1996;  335 1480-1485
    CrossrefPubMedSearch in Google Scholar
  • 13 Lee M I, Todd H M. Plasma catecholamines and angiotensin converting enzyme activity in hypertensive subjects with positive rollover test.  Obstet Gynecol . 1984;  63 511-514
    PubMedSearch in Google Scholar
  • 14 Kanayama N, She L, Maehara K. Induction of HELLP syndrome-like biochemical parameters by stimulation of the celiac ganglion in rats.  J Hypertens . 1996;  14 453-459
    PubMedSearch in Google Scholar
  • 15 Kanayama N, Tsujimura R, She L. Cold-induced stress stimulates the sympathetic nervous system, causing hypertension and proteinuria in rats.  J Hypertens . 1997;  15 383-389
    CrossrefPubMedSearch in Google Scholar
  • 16 Ramos-Santos E, Devoe L D, Wakefield M L. The effects of epidural anesthesia on the Doppler velocimetry of umbilical and uterine arteries in normal and hypertensive patients during active term labor.  Obstet Gynecol . 1991;  77 20-26
    PubMedSearch in Google Scholar
  • 17 Jouppila P, Jouppila R, Hollmen A, Koivula A. Lumbar epidural anesthesia to improve intervillous blood flow during labor in severe preeclampsia.  Obstet Gynecol . 1982;  59 158-161
    PubMedSearch in Google Scholar
  • 18 Kanayama N, Belayet H, Khatun S. A new treatment of severe pre-eclampsia by long-term epidural anaesthesia.  J Hum Hypertens . 1999;  13 167-171
    CrossrefPubMedSearch in Google Scholar