Complicated Post-Partum HELLP Syndrome Causing Acute Renal Failure and a Spontaneous Acute Subdural Hematoma

Abstract

HELLP syndrome is characterized by hemolysis, elevated liver enzymes, and thrombocytopenia. It is a devastating illness that typically occurs in the third trimester of gestation. We present a unique case of complicated post-partum HELLP syndrome. The patient was a 34-year-old Caucasian G1PO woman at 40 weeks’ gestational age who presented for induction of labor. She underwent successful vaginal delivery. However, postoperatively the patient developed HELLP syndrome complicated by acute renal failure. She was transferred to the intensive care unit, where her renal function continued to decline, ultimately necessitating hemodialysis. She subsequently spontaneously developed an acute subdural hematoma. Most cases of HELLP syndrome occur in the third trimester, whereas fewer manifest post-partum. The pathophysiology of HELLP syndrome is poorly understood. While the defining organ of injury in HELLP syndrome is the liver, both kidney injury and spontaneous subdural hematomas can occur, as seen in this patient. The gold standard therapy for HELLP syndrome is prompt delivery of the fetus. HELLP syndrome continues to be a serious constellation of symptoms that can affect women late in their gestational period. As illustrated in this case report, prompt diagnosis of HELLP syndrome and appropriate management is critical.

A atuação dos profissionais de saúde frente a identificação do diagnóstico de síndrome de HELLP e suas complicações

“…As com hipertensão grave necessitam de um anti-hipertensivo, deve ser ficar atento para as mulheres que apresentam dor epigástrica ou no quadrante superior direito necessitam cuidadosamente serem examinadas quanto sangramento ou hemorragia hepática. Os pacientes neste cenário também podem sentir dor no ombro ou nas costas, dispnéia ou náusea e vômito (Shah et al, 2021).…”

“…Portanto, aqueles com sintomas devem ser submetidos a exames de imagem hepática, independentemente dos valores laboratoriais. A ultrassonografia à beira do leito é o exame de escolha para imagens iniciais, que podem ser seguidas com tomografia computadorizada ou ressonância magnética, especialmente quando são necessárias decisões de manejo (Shah et al, 2021).…”

HELLP Syndrome with Unusual Features in a Rare Setting

“…It is also essential that investigations are tailored towards complications in post-partum HELLP syndrome [6,17]. When compared to the antepartum HELLP syndrome, patients who develop post-partum HELLP syndrome have a high tendency of developing acute kidney injury (AKI), pulmonary edema (PE), disseminated intravascular coagulation (DIC), and subscapular liver hematoma [18][19][20]. These complications heighten the morbidity and mortality in cases of post-partum HELLP syndrome [18][19][20].…”

“…When compared to the antepartum HELLP syndrome, patients who develop post-partum HELLP syndrome have a high tendency of developing acute kidney injury (AKI), pulmonary edema (PE), disseminated intravascular coagulation (DIC), and subscapular liver hematoma [18][19][20]. These complications heighten the morbidity and mortality in cases of post-partum HELLP syndrome [18][19][20]. The index case had AKI which was diagnosed and managed promptly but not the other complications.…”

A Rare Case of HELLP Syndrome with Hematomas of Spleen and Liver, Eclampsia, Severe Hypertension and Prolonged Coagulopathy—A Case Report

“…Liver and spleen hematomas rarely entangle (<2%) HELLP cases [7,8], but rupture of the hematomas is a state of immediate threat to life [5,6,9]. Adverse effects in pregnant women with the HELLP syndrome include mainly cerebral bleeding and the development of disseminated intravascular coagulation (DIC), liver and kidney failure as well as heart failure and pulmonary edema [3,[10][11][12][13][14][15]. Maternal mortality in HELLP is estimated at 1-25% [3,15].…”