Pregnant-Postpartum Women with Severe Epigastric Pain and HELLP Syndrome: A Highly Dangerous Combination ()
ABSTRACT
OBJECTIVE: HELLP syndrome is a severe preeclampsia spectrum
disorder diagnosed when laboratory evidence of hemolysis, liver dysfunction and
thrombocytopenia are present. The presence of epigastric pain with laboratory
criteria for HELLP syndrome may indicate higher maternal-fetal risk. Thus we
explored maternal outcomes in 42 pregnant/postpartum women that had HELLP syndrome
by laboratory criteria in addition to sudden severe epigastric pain. METHODS: A database was constructed from the medical files of all patients with
medical/hypertensive disorders evaluated by the first author from 1986-2015 for
medicolegal purposes. All patient files of women who presented to their
physicians with a diagnosis of presumptive HELLP syndrome were examined. RESULTS: Fifty-eight pregnant/postpartum women fulfilled study
inclusion criteria; they presented to physicians for evaluation usually in
non-tertiary care hospital settings. Clinical presentation and care including
lab data and details of pregnancy outcome were evaluated. A correct diagnosis
of HELLP syndrome was verified for 42 women (72.4%); others were determined to
have AFLP-Acute Fatty Liver of Pregnancy (n = 8) or TTP-aHUS-Thrombotic thrombocytopenic
purpura-adult/atypical hemolytic uremic syndrome (n = 8). All 42 HELLP women (100%) in our cohort had
severe epigastric pain. Treatment modalities for maternal HELLP syndrome
included magnesium sulfate (n = 35, 83%), antihypertensives (n = 17, 40%); corticosteroids (CORT) for HELLP were not
utilized. Major maternal morbidity (21 strokes, 9 liver ruptures/hematomas)
affected 41 HELLP women (98%); 22 died, 7 were permanently disabled. CONCLUSION: HELLP syndrome patients presenting with sudden, severe epigastric pain in
this highly selected cohort experienced very high maternal morbidity and
mortality. Laboratory evidence of HELLP syndrome in association with epigastric
pain is a dangerous combination that portends great danger to safe motherhood.
We speculate that the absence of CORT use in this cohort contributed to poor
maternal outcome (word count = 280 as modified for reviewers).
Share and Cite:
Martin Jr., J. and Tucker, J. (2021) Pregnant-Postpartum Women with Severe Epigastric Pain and HELLP Syndrome: A Highly Dangerous Combination.
Open Journal of Obstetrics and Gynecology,
11, 1081-1091. doi:
10.4236/ojog.2021.118101.
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