HELLP syndrome; haemolysis, elevated liver enzymes and low platelets may be regarded as a variant or complication of severe pre-eclampsia occurring in 0.5–0.9% of all pregnancies and in 10–20% of cases of severe pre-eclampsia1. It is associated with increased maternal morbidity and mortality.2 Onset earlier than 28 weeks is rare and there is little published data on maternal and perinatal outcome.1 3 We present a case of severe pre-eclampsia complicated by HELLP syndrome at only 21 weeks gestation.
A 38 year old primiparous patient presented at 21 weeks gestation with headache, visual disturbance and generalised oedema. She was severely hypertensive with significant proteinuria. Following admission she developed haematological and biochemical features of HELLP syndrome with a normal glucose level.
Due to her worsening clinical and haematological condition she was commenced on magnesium sulphate infusion, methyldopa and her pregnancy was terminated with misoprostol therapy. Following 2 cycles of treatment she progressed to a normal vaginal delivery of an 18 week size stillborn male.
After delivery there was marked improvement in blood pressure and haematological markers. Postnatally labetolol controlled blood pressure well. Investigations for underlying pathology included; anti-phospholipid screen, homocysteine, anticardiolipin antibodies, lupus anticoagulant and renal artery and Doppler ultrasound. These were normal. The patient was discharged to primary care on postnatal day 6 and has expressed a keen desire for subsequent pregnancy. As this patients recurrence risk is high4 she required counselling for future pregnancy.
Sibai BM. HELLP Syndrome, UpToDate (Sept 2012), http://www.uptodate.com/contents/hellp-syndrome (accessed October 2012).
Paruk F and Moodley J. Maternal and neonatal outcome in early- and late-onset pre-eclampsia. Seminars in Neonatology 2000;5:197-207.
Sibai BM. Evaluation and management of severe preeclampsia before 34 weeks’ gestation. American Journal of Obstetrics and Gynecology 2011;205:191-198.
August P, Sibai BM. Preeclampsia: Clinical features and diagnosis, UpToDate (Sept 2012), http://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis (accessed October 2012).
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