P 32 Postpartum HELLP syndrome – A case report

Abstract

Introduction HELLP syndrome is a life-threatening obstetric condition and one of the particularly severe forms of preeclampsia. Objective The purpose of this paper is to present a case of preeclamptic patient with HELLP syndrome diagnosed on 2 day after delivery by the cesarean section. Objective A 32-year-old primigravida at 38 + 1 week of gestation was admitted to the tertiary care hospital with PROM, severe hypertension, proteinuria and generalized oedema. Four weeks earlier i.e., at 35 week of gestation, the patient had her last appointment at an outpatients clinic. She was started on antihypertensive therapy and was transported to the operating theatre. The lower segment caesarean section under general anesthesia was carried out that resulted in a son born. At birth, the boy weighed 2190 g. On the second day after the cesarean section, the patient developed diffused haematoma within the abdominal wall. Laboratory tests revealed clinically significant renal and liver dysfunction and thrombocytopenia. HELLP syndrome was diagnosed. The therapy with intravenous Dexamethasone was initiated. Metyldopa in a dose of 500 mg four times daily was continued, some ice gel packs were applied on the haematoma of the abdominal The antibiotic therapy was administered for 7 days. The patient was under close surveillance. We observed continuous gradual progressive improvement in the patient’s condition and her laboratory tests. The blood coagulation function improved. Liver enzymes began to decrease on day 5 and normalized on day 8 after the C-section. The diffused haematoma on the abdominal wall and pubic symphysis disappeared after 5 days. The patient was discharged on day 11 after the C-section with recommendations that involved taking of Methyldopa, systematic control of blood pressure and a follow-up appointment at the Outpatient Nephrological Clinic. Conclusions Although delivery of the infant and placenta constitutes the curative treatment of HELLP, it may occur also in the postpartum period. HELLP syndrome is always a serious and potentially fatal obstetric condition however, it is reversible if an adequate diagnosis is promptly made and emergency intensive treatment is immediately administered. Patients with HELLP syndrome should be treated in a tertiary perinatal care centre with the intensive care unit.