Clinical feature | Preeclampsia/HELLP | TTP | C-TMA | ITP | Hemorrhage/DIC | Sepsis/DIC |
Incidence | 100 in 10,000 pregnancies | 1 in 10,000 pregnancies | Unknown. May be similar to TTP. | 3 in 10,000 pregnancies | 2 in 10,000 pregnancies | 1 in 10,000 pregnancies |
Time of occurrence | By definition, occurs after 20 weeks of gestation; more common near term and within three days postpartum | May occur throughout pregnancy, but most common near term and several weeks postpartum | May occur throughout pregnancy, but most common postpartum | Any time during pregnancy | Most commonly at delivery and postpartum | Most commonly at delivery and postpartum |
Vital signs | Hypertension, by definition, BP ≥160/110 | Normal BP, fever may be present but is rare | Hypertension due to AKI | Normal, unless hypotension and tachycardia from bleeding | Hypotension, tachycardia (may have been transient) | Fever, hypotension, tachycardia |
Neurologic abnormalities | Headache, vision changes. Less commonly eclamptic seizures, PRES, stroke. | Severe in 41% (transient focal defects, seizure, stroke); minor in 30% | None | None | Probably none | Probably none |
Microangiopathic hemolysis/schistocytes | Moderate | Severe | Moderate | None | Variable | Variable |
Kidney injury | Usually mild, but severe AKI is possible. Dialysis is rarely required. | Usually mild or absent; severe AKI requiring dialysis in <5% | Severe, typically dialysis is required | None | Severe ATN, reversible | May have ATN, reversible |
Liver function tests: ALT, AST | From normal to markedly increased | Normal or slightly increased | Normal | Normal | May be markedly increased | May be increased |
Typical course following delivery | Stabilization or improvement within 48 hours | No stabilization or improvement within 48 hours | Increasing serum creatinine | Most unchanged, but may improve after delivery | Recovery after source of hemorrhage corrected | Recovery after appropriate treatment |
Specific management | Delivery of infant is curative | For immune TTP, plasma exchange and immunosuppression. For hereditary TTP, plasma infusion (or other source of ADAMTS13). | Anti-complement agent | Glucocorticoids, IVIG, and maybe additional immunosuppressive agents and/or a thrombopoietin receptor agonist (TPO-RA) for refractory disease | Identify and correct source of hemorrhage. May require additional laparotomy. | Antibiotics |
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