The diagnosis of HELLP syndrome associated with preeclampsia-eclampsia during pregnancy uses three test results, including hemolysis, elevated liver enzyme, low platelets and their related clinical symptoms. Liver rupture is a life-threatening and rare complication related to HELLP syndrome. Early diagnosis and rapid treatment are very important for protecting the life of the patient and the fetus. We are reporting an anesthetic experience a sudden-onset suspicious HELLP syndrome with an intraperitoneal hemorrhage caused by a rapidly progressed liver rupture in a severe preeclampsia patient without any abnormalities during gestation.
Diagnosis ; Early Diagnosis ; Eclampsia ; Female ; Fetus ; HELLP Syndrome* ; Hemolysis ; Hemorrhage* ; Humans ; Liver* ; Pre-Eclampsia* ; Pregnancy ; Rupture*

Spontaneous hepatic rupture, which is a complication of hypertension in pregnancy, is extremely rare. However, high maternal and perinatal mortality rates are observed. Several factors, namely, age over 30 years, multiparity, severe preeclampsia, or HELLP syndrome (a group of symptoms which include hemolytic anemia, hepatic enzyme increase, and thrombocytopenia), are associated with this condition. An autopsy case of a woman with twin pregnancy was studied. She was at 36 weeks of gestational age and suffered from the sudden development and rapid progression of hypertension. Moreover, she died because of spontaneous hepatic rupture despite an emergency operation. Autopsy revealed a capsular rupture of the right lobe of the liver with numerous blood clots and hypovolemic signs, such as weak postmortem lividity and palor of the skin and conjunctiva. A close examination of the trunk and liver for the classification of the cause of rupture and an assessment of medical history, such as preeclampsia, are needed during postmortem examination of pregnant women with hepatic rupture or her fetus. To the best of our knowledge, this fatal complication in pregnant women is not yet presented in postmortem examinations in Korea. Thus, we report the findings of this case to share the knowledge.
Anemia, Hemolytic ; Autopsy* ; Classification ; Conjunctiva ; Emergencies ; Female ; Fetus ; Gestational Age ; HELLP Syndrome ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced ; Hypovolemia ; Korea ; Liver ; Parity ; Perinatal Mortality ; Pre-Eclampsia* ; Pregnancy ; Pregnancy, Twin ; Pregnant Women* ; Rupture* ; Rupture, Spontaneous ; Skin

Gitelman syndrome is characterized by hypokalemia, metabolic alkalosis, hypocalciuria, and hypomagnesemia. The clinical course of Gitelman syndrome in pregnant women remains unclear, but it is thought to be benign. We report here the first Korean case of atypical eclampsia in a 31-year-old who was diagnosed with Gitelman syndrome incidentally during an antenatal screening test. The patient did well during pregnancy despite significant hypokalemia. At 33 weeks’ gestation, the patient exhibited eclampsia, hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, and renal insufficiency without significant hypertension or proteinuria. We explain this unusual clinical course through a review of the relevant literature.
Adult ; Alkalosis ; Eclampsia ; Female ; Gitelman Syndrome* ; HELLP Syndrome* ; Hemolysis ; Humans ; Hypertension ; Hypokalemia ; Liver ; Pregnancy ; Pregnant Women ; Prenatal Diagnosis ; Proteinuria ; Renal Insufficiency

A 30-year-old female patient, 18 weeks gestational age, with no prior medical history was admitted to hospital complaining severe right upper quadrant pain. The patient was admitted to intensive care unit (ICU) after emergency surgery to treat intraperitoneal hemorrhage caused by rupture of liver hematoma. Despite the absence of high blood pressure, the patient was diagnosed with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome on the basis of abnormal levels of blood aspartate aminotransferase/alanine aminotransferase, lactate dehydrogenase, total bilirubin, direct bilirubin, C-reactive protein (CRP) and platelet along with liver damage and proteinuria. While in ICU, the patient was given total parenteral nutrition (TPN) and enteral nutrition (EN) for –20 days because oral feeding was impractical. In the early stage, TPN supply was not sufficient to meet the elevated nutritional demand induced by disease and surgery. Nevertheless, continuous care of nutrition support team enabled satisfactory EN and, subsequently, oral feeding which led to improvement in patient outcome.
Adult ; Aspartic Acid ; Bilirubin ; Blood Platelets ; C-Reactive Protein ; Emergencies ; Enteral Nutrition ; Female ; Gestational Age ; HELLP Syndrome* ; Hematoma ; Hemolysis ; Hemorrhage ; Humans ; Hypertension ; Intensive Care Units ; L-Lactate Dehydrogenase ; Liver ; Parenteral Nutrition ; Parenteral Nutrition, Total ; Platelet Count ; Pregnancy ; Proteinuria ; Rupture

The case of a pregnant woman initially presenting with low platelets and low haemoglobin and subsequently diagnosed as a case of Evans Syndrome is presented. Owing to its extremely low incidence, little research exists investigating pregnancies complicated by Evans Syndrome. Although diagnosis is simple and straightforward, management of a pregnancy of this nature has proven to be complex and challenging. Further complicating the case and its management is the concurrent diagnosis of Chronic Hypertension with Superimposed Pre-eclampsia, in complete HELLP Syndrome. Pre-eclampsia in the background of Evans Syndrome makes this case a truly interesting case. The individual effects of the two disease entities in a single patient are discussed in this report.

Human ; Female ; Adult ; Pregnancy ; Hellp Syndrome ; Pre-eclampsia ; Evans Syndrome ; Thrombocytopenia ; Anemia, Hemolytic, Autoimmune ; Blood Platelet Disorders ; Hematologic Diseases ; Hypertension

The case of a pregnant woman initially presenting with low platelets and low haemoglobin and subsequently diagnosed as a case of Evans Syndrome is presented. Owing to its extremely low incidence, little research exists investigating pregnancies complicated by Evans Syndrome. Although diagnosis is simple and straightforward, management of a pregnancy of this nature has proven to be complex and challenging. Further complicating the case and its management is the concurrent diagnosis of Chronic Hypertension with Superimposed Pre-eclampsia, in complete HELLP Syndrome. Pre-eclampsia in the background of Evans Syndrome makes this case a truly interesting case. The individual effects of the two disease entities in a single patient are discussed in this report.

Human ; Female ; Adult ; Pregnancy ; Hellp Syndrome ; Pre-eclampsia ; Evans Syndrome ; Thrombocytopenia ; Anemia, Hemolytic, Autoimmune ; Blood Platelet Disorders ; Hematologic Diseases ; Hypertension

Transfusion-related acute lung injury (TRALI) is a serious adverse reaction of transfusion, and presents as hypoxemia and non-cardiogenic pulmonary edema within 6 hours of transfusion. A 14-year-old primigravida woman at 34 weeks of gestation presented with upper abdominal pain without dyspnea. Because she showed the syndrome of HELLP (hemolysis, elevated liver enzymes, and low platelet count), an emergency cesarean section delivery was performed, and blood was transfused. In the case of such patients, clinicians should closely observe the patient's condition at least during the 6 hours while the patient receives blood transfusion, and should suspect TRALI if the patient complains of respiratory symptoms such as dyspnea. Furthermore, echocardiography should be performed to distinguish between the different types of transfusion-related adverse reactions.
Abdominal Pain ; Acute Lung Injury* ; Adolescent ; Anoxia ; Blood Platelets ; Blood Transfusion ; Cesarean Section* ; Dyspnea ; Echocardiography ; Emergencies ; Female ; HELLP Syndrome* ; Humans ; Liver ; Pregnancy ; Pulmonary Edema

Pregnant women with antiphospholipid syndrome (APS) carry a high risk of arterial or venous thrombosis. Such thrombotic conditions occur more frequently in patients with triple positivity to antiphospholipid antibodies or with high antibody titers. Hepatic infarction is a rare complication in pregnant women with APS, and it sometimes mimics HELLP syndrome. This report describes a preeclamptic pregnant woman with APS who had high titers of three antiphospholipid antibodies. She experienced severe epigastric pain with elevated liver enzymes; in addition, she had tachycardia and tachypnea. The clinical findings suggested hepatic infarction and pulmonary thromboembolism, a partial manifestation of catastrophic APS. Therefore, she underwent emergent cesarean section at 25+2 weeks of gestation. After the delivery, her laboratory test indicated HELLP-like features, and computed tomography confirmed hepatic infarction and pulmonary micro-thromboembolism. Here, we report a case of a partial manifestation of catastrophic APS in a pregnant woman with triple antibody positivity, including a brief literature review.
Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Cesarean Section ; Female ; HELLP Syndrome ; Humans ; Infarction* ; Liver ; Pregnancy ; Pregnant Women* ; Pulmonary Embolism ; Tachycardia ; Tachypnea ; Venous Thrombosis

Pregnant women with antiphospholipid syndrome (APS) carry a high risk of arterial or venous thrombosis. Such thrombotic conditions occur more frequently in patients with triple positivity to antiphospholipid antibodies or with high antibody titers. Hepatic infarction is a rare complication in pregnant women with APS, and it sometimes mimics HELLP syndrome. This report describes a preeclamptic pregnant woman with APS who had high titers of three antiphospholipid antibodies. She experienced severe epigastric pain with elevated liver enzymes; in addition, she had tachycardia and tachypnea. The clinical findings suggested hepatic infarction and pulmonary thromboembolism, a partial manifestation of catastrophic APS. Therefore, she underwent emergent cesarean section at 25+2 weeks of gestation. After the delivery, her laboratory test indicated HELLP-like features, and computed tomography confirmed hepatic infarction and pulmonary micro-thromboembolism. Here, we report a case of a partial manifestation of catastrophic APS in a pregnant woman with triple antibody positivity, including a brief literature review.
Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Cesarean Section ; Female ; HELLP Syndrome ; Humans ; Infarction* ; Liver ; Pregnancy ; Pregnant Women* ; Pulmonary Embolism ; Tachycardia ; Tachypnea ; Venous Thrombosis

We report a case of posterior reversible encephalopathy syndrome in association with hemolysis-elevated liver enzymes-low platelet counts (HELLP) syndrome. A 29-year-old primigravida presented at 35 weeks 4 days pregnancy with headache and blurred vision and the laboratory data revealed hemolysis, elevated liver enzymes, and low platelets. Cranial magnetic resonance imaging (MRI) showed hyperintense signal changes in the right occipital, left cerebellar regions and the right thalamus. Follow up brain MRI 10 days after the caesarean section showed resolution of the previous abnormalities. Posterior reversible encephalopathy syndrome (PRES) is a neuroradiologic condition associated with headache, seizures, altered sensorium, and visual disturbances. Although their association is rare, the diagnosis of PRES should be considered in all HELLP patients presenting with headache and neuro-ophthalmic signs. It is for the reason that the patients can recover well with complete reversal of clinical symptoms within several days, when adequate treatment is immediately initiated.
HELLP Syndrome