Fulminant course of HELLP syndrome with lethal outcome – case report

Authors: D. Drmlová;  H. Brádková;  Š. Urbánek
Authors‘ workplace: Gynekologicko-porodnické oddělení, Oblastní nemocnice Kladno a. s., primář MUDr. P. Ullrych
Published in: Čes. Gynek.2013, 78, č. 5 s. 460-463
Category: Original Article


To present a case of death of a patient with fulminant course of HELLP syndrome in 32nd week of pregnancy.

Case report.

Department of Obstetrics and Gynecology, Hospital Kladno.

Case report:
We report a case of 29 years old primigravida in 32nd week of pregnancy, which was admitted to the hospital in a serious condition with cephalea, vomiting and progressive full-body swelling. During the entrance examination the patient looses consciousness, due to critical pressure an emergency caesarian section is performed. Laboratory values correspond to a fully developed HELLP syndrome, which gradually progresses from class III to class I of Mississippi classification. The patient´s condition required further surgical interventions including hysterectomy. Despite intensive therapy and multidisciplinary cooperation a gradual failure of vital functions and death of the patient followed.

Presenting this critical situation the authors want to emphasize the need of early diagnosis and subsequent comprehensive treatment in cooperation with other disciplines in the care of critically endangered patient on delivery room.

HELLP syndrome – maternal death


1. Amorim, M., Katz, L. Corticosteroids for HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy: RHL commentary (last revised: 1 May 2011) [cit. 2013-5-20]. The WHO Reproductive Health Library; Geneva: World Health Organization. Dostupné z: http://apps.who.int/rhl/pregnancy_childbirth/medical/hypertension/cd008148_amorimm_com/en/

2. Čech, E., Hájek, Z., Maršál, K., et al. Porodnictví. 2. vyd., Praha: Grada, 2006, s. 262–263.

3. Gumulec, J., Kula, R., Pleva, L. Diferenciální diagnostika trombocytopenie u kriticky nemocných pacientů [online]. 25.3.2010 [cit.2013-5-20]. ISSN 1804-8382. Dostupné z: http://www.trombocytopenie.cz/clanek.php?id=16&tab=lekar

4. Hájek, Z., et al. Rizikové a patologické těhotenství. 1. vyd., Praha: Grada, 2004, s. 95–107.

5. Haram, K., Svendsen, E., Abildgaard, U. The HELLP syndrome: Clinical issues and management. BMC Pregnancy Childbirth [online]. 26.2.2009 [cit.2013-5-20]. Dostupné z: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654858/

6. Isler, CM., Rinehart, BK., Terrone,DA., et al. Maternal mortality associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. AJOG, 1999, 181(4), p. 924–928.

7. Katz, VL., Watson, WJ., Thorp, JM. Jr., et al. Treatment of persistent postpartum HELLP syndrome with plasmapheresis. Am J Perinatol., 1992, 9, p. 120–122.

8. Lipka, R. HELLP syndrom. Gynekolog [online]. 2006 [cit.2013-5-20]. Dostupné z: http://www.gyne.cz/clanky/2006/206cl2.htm

9. Martin, JN. Jr, Files, JC., Black, PG., et al. Plasma exchange for preeclampsia. Postpartum use for persistently severe preeclampsia- eclampsia with HELLP syndrome. AJOG, 1990, 162, p. 126.

10. O’Hara Padden, M. HELLP Syndrome: Recognition and Perinatal Management, Am Fam Physician., 1999, 60(3), p. 829–836.

11. Owens, MY, Martin, JN. Jr., Wallace, K., et al. Postpartum thrombotic microangiopathic syndrome. Transfus Apher Sci, 2013, 48(1), p. 51–57.

12. Šimetka O., Pařízek, A. HELLP syndrom. In Pařízek, A., a kol. Kritické stavy v porodnictví. Praha: Galén, 2012, s. 75–78.

13. Šimetka, O., Brychtová, P., Procházková, J., Procházka, M.Laboratorní změny aktivace endotelu u syndromu HELLP. Gynekolog, 2008(2), s. 48–53.

14. Šimetka, O., Michalec, I., Zewdiová, H., et al. Průběh a výsledky 34 těhotenství komplikovaných syndromem HELLP. Čes Gynek, 2010, 75(3), s. 242–247.

15. Sibai, BM., Ramadan, MK., Usta, I., et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome), AJOG, 1993, 169, p. 1000–1006.

16. Woudstra, DM., Chandra, S., et al. Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy. Cochrane Database of Systematic Reviews 2010, Issue 9. [cit.2013-5-20] Art. No.: CD008148. Dostupné z.: http://www.ncbi.nlm.nih.gov/pubmed/20824872

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
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