Ugeskrift for laeger
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Ugeskrift for laeger · May 1991
Review[Quality assurance in antenatal, perinatal and neonatal care. A medical audit].
Formalized quality assessment of prophylaxis, diagnosis, treatment, and care has recently been introduced in the Danish health service. A review is presented of quality assessment undertaken by the medical audit method and a model is described for quality assurance of prophylaxis, diagnosis, treatment and care during the ante-, peri and neonatal periods. The information is based partly on results from a medical audit project and also experience from work in a perinatal committee in the County of Copenhagen. ⋯ In addition, examples are quoted of criteria for satisfactory prophylaxis, diagnosis, treatment and care in the perinatal period and for how assessment by the specialists is carried out. A new classification of causes of death and review of the results of assessments of quality is presented. Finally, quality assessment as seen from the patients' point of view is discussed.
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Ugeskrift for laeger · May 1991
Case Reports[Hemolysis, elevated liver enzymes and thrombocytopenia: the HELLP syndrome--a manifestation of severe pre-eclampsia].
On the basis of a review of the literature and five case histories, the pathophysiological and clinical features in pregnant women with haemolysis, elevated liver enzymes and thrombocytopenia which together constitute the HELLP syndrome (haemolysis, elevated liver enzymes and low platelet count) are illustrated. This syndrome describes a complicated obstetric course with greatly increased neonatal and maternal morbidities. Hypertension/proteinuria are common but are not obligatory. ⋯ In exceptional cases cesarean section may be necessary. On the basis of the coagulation status, the defective plasma components may be supplied (e.g. fresh frozen plasma and antithrombin-III). Plasmapheresis and specific pharmacological intervention must be considered as experimental at present, although these present promising therapeutic possibilities.