HELLP Syndrome

Patient presentation:
K.W. is a 27 year old female with no medical history of surgeries or medical conditions. Pt is G1P0, 37.3 weeks pregnant. Pt arrived to hospital in labor, after rapid labor, pt delivered vaginally. APGAR 8/9. Baby boy at 7 lbs 13 oz. Pt received epidural, intact perineum, no complications from delivery, EBL 250cc. In recovery BP noted to be 150-160/90s. Pt stayed in labor and delivery to further assess BP; CBC & PIH panel drawn. Labs came back with H/H 9/36%; Platelets 100 (normal 140-440); ALT 150 (normal 9-72 U/L); AST 200 (normal 14-59 U/L); uric acid 7.2 (2.5-8.5 mg/dL). Based on these labs the physician started her on Magnesium Sulfate 2 grams/hr IV.

Differentials:
Pre-eclampsia, HELLP Syndrome

Diagnosis & outcome:
Throughout the night, the patient continued to decline with the abdomen becoming distended and tender. OB consulting with MFM (Maternal Fetal Specialist) as to plan of care as pt continues to complain of severe right epigastric pain and head ache (rated epigastric pain 8/10). Pt BP stable around 150/85. Pt afebrile; O2 sat 95% RA; R 20. Labs drawn q4h, with platelets continuing to decrease and liver enzymes continuing to increase. Around 2300 labs show Plt 70; ALT 1600 (normal is 9-72); and AST 2200. MD orders liver ultrasound to assess for hemorrhages. MD orders consult with hospital general surgeon "in case of liver rupture." Urine output decreasing to around 40 cc/hr; DTR 1+; decreased LOC (pt appearing lethargic and drowsy). Labs stabilized around 0200, and for the next 24 hours trending toward normal. Magnesium Sulfate discontinued after 36 hours, pt recovered fully and was discharged home after 4 days in hospital.

Case created by Katherine Whitmire, 2011.