Write your message
Volume 3, Issue 4 (Fall 2018)                   jogcr 2018, 3(4): 173-176 | Back to browse issues page


XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Ayati S, Pourali L, Vatanchi A, Jedi L, Mohades Ardebili Z. Maternal Death Following Misdiagnosis of Emolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) Syndrome: A Case Report and Review of Literature. jogcr. 2018; 3 (4) :173-176
URL: http://jogcr.com/article-1-180-en.html
1- Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2- Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran , pouralil@mums.ac.ir
3- General Practitioner, Tehran University of Medical Sciences, Tehran, Iran
Abstract:   (147 Views)

Background & Objective: HELLP syndrome is characterized by hemolysis, elevated liver enzymes, and low platelet count; it probably shows a severe form of preeclampsia. This syndrome usually occurs in third trimester of pregnancy and may be associated with severe complications, including subcapsular liver hematoma, eclampsia, pulmonary edema, liver or renal dysfunction, and even maternal death. This study aimed to report a case of maternal death misdiagnosis of HELLP syndrome.
Case Report: A 28-year-old pregnant woman with gestational age of 28 weeks referred to an emergency ward because of epigastric pain, nausea, and vomiting. She was discharged after receiving outpatient treatment. The next day, she was referred to the hospital because of seizure, decreased level of consciousness, and hypertension. A cesarean section was performed immediately. Unfortunately, some hours after the surgery, cardiac arrest occurred and she died in intensive care unit (ICU).
Conclusion: Nausea, vomiting, and epigastric pain in the late second or third trimester of pregnancy are among the significant symptoms which should be seriously taken into consideration. Therefore, it is recommended that a patient be hospitalized and precise evaluation be performed to rule out the life-threatening differential diagnoses, like HELLP syndrome, and to prevent dangerous complications which can lead to maternal death.

Full-Text [PDF 209 kb]   (45 Downloads) |   |   Full-Text (HTML)  (10 Views)  

✅ Nausea, vomiting, and epigastric pain in the late second or third trimester of pregnancy are among the significant symptoms which should be seriously taken into consideration. Therefore, it is recommended that a patient be hospitalized and precise evaluation be performed to rule out the life-threatening differential diagnoses, like HELLP syndrome, and to prevent dangerous complications which can lead to maternal death.


Systematic Review: Case Report | Subject: Obstetrics and Gynecology
Received: 2018/07/12 | Accepted: 2018/08/20 | Published: 2018/09/16

References
1. Joshi D, James A, Quaglia A, Westbrook RH, Heneghan MA. Liver disease in pregnancy. Lancet. 2010; 375(9714): 594-605. [DOI:10.1016/S0140-6736(09)61495-1] [DOI:10.1016/S0140-6736(09)61495-1]
2. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dahshe JS, Hoffman BL, et al. Williams Obstetrics. 24th ed. Mc Graw Hill. 2014; p. 742.
3. Hammoud GM, Ibdah JA. Preeclampsia-induced Liver Dysfunction, HELLP Syndrome, and Acute Fatty Liver of Pregnancy. Clin Liver Dis. 2014; 4(3): 69-73. [DOI:10.1002/cld.409] [PMID] [PMCID] [DOI:10.1002/cld.409] [PMID] [PMCID]
4. Benedetto C, Marozio L, Tancredi A, Picardo E, Nardolillo P, Tavella AM, et al. Biochemistry of HELLP syndrome. Adv Clin Chem 2011; 53:85. [DOI:10.1016/B978-0-12-385855-9.00004-7] [DOI:10.1016/B978-0-12-385855-9.00004-7] [PMID]
5. Koenen SV, Huisjes AJ, Dings J, van der Graaf Y, Visser GH, Bruinse HW. Is there a diurnal pattern in the clinical symptoms of HELLP syndrome? J Matern Fetal Neonatal Med. 2006; 19(2): 93-9. [DOI:10.1080/14767050500380976] [PMID] [DOI:10.1080/14767050500380976] [PMID]
6. Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: Clinical issues and management. A Review. BMC Pregnancy Childbirth. 2009; 9: 8. [DOI:10.1186/1471-2393-9-8] [PMID] [PMCID] [DOI:10.1186/1471-2393-9-8] [PMID] [PMCID]
7. Abildgaard U, Heimdal K. Pathogenesis of the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP): a review. Eur J Obstet Gynecol Reprod Biol 2013; 166: 117. [DOI:10.1016/j.ejogrb.2012.09.026] [PMID] [DOI:10.1016/j.ejogrb.2012.09.026] [PMID]
8. Martin JN Jr, Rose CH, Briery CM. Understanding and managing HELLP syndrome: the integral role of aggressive glucocorticoids for mother and child. Am J Obstet Gynecol 2006; 195: 914. [DOI:10.1016/j.ajog.2005.08.044] [PMID] [DOI:10.1016/j.ajog.2005.08.044] [PMID]
9. American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122: 1122.
10. Fitzpatrick KE, Hinshaw K, Kurinczuk JJ, Knight M. Risk factors, management, and outcomes of hemolysis, elevated liver enzymes, and low platelets syndrome and elevated liver enzymes, low platelets syndrome. Obstet Gynecol 2014; 123: 618. [DOI:10.1097/AOG.0000000000000140] [PMID] [DOI:10.1097/AOG.0000000000000140] [PMID]
11. Andersgaard AB, Herbst A, Johansen M, Ivarsson A, Ingemarsson I, Langhoff-Roos J, et al. Eclampsia in Scandinavia: incidence, substandard care, and potentially preventable cases. Acta Obstet Gynecol Scand. 2006; 85(8): 929-36. [DOI:10.1080/00016340600607149] [PMID] [DOI:10.1080/00016340600607149] [PMID]
12. Erkılınç S, Eyi EGY. Factors contributing to adverse maternal outcomes in patients with HELLP syndrome. J Matern Fetal Neonatal Med. 2017: 1-7.
13. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dahshe JS, Hoffman BL, et al. Williams Obstetrics. 24th ed. Mc Graw Hill. 2014; p.756.
14. Berhan Y, Berhan A. Should magnesium sulfate be administered to women with mild pre-eclampsia? A systematic review of published reports on eclampsia. J Obstet Gynaecol Res. 2015; 41(6): 831-42. [DOI:10.1111/jog.12697] [PMID] [DOI:10.1111/jog.12697] [PMID]
15. Thornton C, Dahlen H, Korda A, Hennessy A. The incidence of preeclampsia and eclampsia and associated maternal mortality in Australia from population-linked datasets: 2000-2008. Am J Obstet Gynecol. 2013; 208(6): 476.e1-5. [DOI:10.1016/j.ajog.2013.02.042] [PMID] [DOI:10.1016/j.ajog.2013.02.042] [PMID]
16. Zwart JJ, Richters A, Ory F, de Vries JI, Bloemenkamp KW, van Roosmalen J. Eclampsia in the Netherlands. Obstet Gynecol. 2008 Oct; 112(4): 820-7. [DOI:10.1097/AOG.0b013e3181875eb3] [PMID] [DOI:10.1097/AOG.0b013e3181875eb3] [PMID]
17. Jaatinen N, Ekholm E. Eclampsia in Finland; 2006 to 2010. Acta Obstet Gynecol Scand. 2016; 95(7): 787-92. [DOI:10.1111/aogs.12882] [PMID] [DOI:10.1111/aogs.12882] [PMID]
18. Cavkaytar S, Ugurlu EN, Karaer A, Tapisiz OL, Danisman N. Are clinical symptoms more predictive than laboratory parameters for adverse maternal outcome in HELLP syndrome? Acta Obstet Gynecol Scand. 2007; 86: 648-651. [DOI:10.1080/00016340601185384] [PMID] [DOI:10.1080/00016340601185384] [PMID]
19. Aagaard-Tillery KM, Belfort MA. Eclampsia: morbidity, mortality, and management. Clin Obstet Gynecol. 2005; 48(1): 12-23. [DOI:10.1097/01.grf.0000153882.58132.ba] [PMID] [DOI:10.1097/01.grf.0000153882.58132.ba] [PMID]
20. Liu S, Joseph KS, Liston RM, Bartholomew S, Walker M, León JA, et al. Incidence, risk factors, and associated complications of eclampsia. Obstet Gynecol. 2011; 118(5): 987-94. [DOI:10.1097/AOG.0b013e31823311c1] [PMID] [DOI:10.1097/AOG.0b013e31823311c1] [PMID]
21. Gul A, Cebeci A, Aslan H, Polat I, Ozdemir A, Ceylan Y. Perinatal outcomes in severe preeclampsia-eclampsia with and without HELLP syndrome. Gynecol Obstet Invest. 2005; 59: 113-118. [DOI:10.1159/000082648] [PMID] [DOI:10.1159/000082648] [PMID]
22. Osmanagaoglu MA, Erdogan I, Zengin U, Bozkaya H. Comparison between HELLP syndrome, chronic hypertension, and superimposed preeclampsia on chronic hypertension without HELLP syndrome. J Perinat Med. 2004; 32: 481-485. [DOI:10.1515/JPM.2004.132] [PMID] [DOI:10.1515/JPM.2004.132] [PMID]

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


© 2019 All Rights Reserved | Journal of Obstetrics, Gynecology and Cancer Research (JOGCR)

Designed & Developed by : Yektaweb | Piblisher: Farname Inc.