According to the medical reports Shaina, aged 24, was expecting her first child. Her pregnancy was normal at the initial stages, with only an episode of high blood pressure at week 34, which was controlled well and due investigation revealed nothing remarkable. However, near the end of her pregnancy, at 37 weeks gestation, she was rushed to the hospital, with severe high blood pressure, great discomfort and fatigue. Anticipating by the symptoms presented, she underwent some tests and investigation. Due condition revealed her to be critically ill and suffering of a syndrome which no one was expecting – Hemolysis, Elevated Liver enzymes, and Low platelet count or HELLP Syndrome.
Dr Shilva, Shaina’s treating doctor and Sr Consultant Obstetrics & Gynecolgy at Paras Bliss Hospital shares, “During her routine last trimester medical check up, we recorded an elevated blood pressure reading of 170/110. Further investigations revealed elevated liver enzymes and low platelet count, with lactate dehydrogenase levels ranging up to 632. We suspected that Shaina was suffering from a rare condition called HELLP syndrome. Further testing and diagnosis proved the same.”
Dr Shilva adds, “Such conditions are rare and are not found in routine basis during pregnancy. It also needs immediate medical attention and timely management. Any delay in diagnosis or treatment can impact the life of the expecting mother and the baby.”
HELLP syndrome is considered as a variant of preeclampsia, which usually has symptoms of high blood pressure and release of significant amount of protein through urine, and leads to low platelet count and breaking down of red blood cells. The chances of the birth of a deformed baby or even a still-birth are high in such cases. HELLP is the short form for Hemolysis, Elevated Liver enzymes, and Low platelet count, which are the key symptoms of this disorder, and doctors are still unaware of the factors triggering the syndrome.
“HELLP syndrome is a severe complication of pregnancy characterized by elevated liver enzymes, haemolysis and low platelet count. Some patients develop just one or two of the characteristics of this syndrome which is termed partial HELLP syndrome. The incidence of HELLP syndrome is 2 to 12%, HELLP syndrome may be associated with serious liver manifestations due to inadequate oxygen delivery, bleeding or rapture. HELLP syndrome usually begins during third trimester and usually considered to be a variant of preeclampsia. Pregnant women with HELLP syndrome often appear normal and early symptoms include epigastric pain, malaise, nausea, vomiting 30% patients present with headache. Early diagnosis helps in reducing morbidity and if not treated timely women can become critically ill. The only effective treatment is prompt delivery of the baby. ” saidDr Shilva, Senior Consultant Obstetrics and Gynaecology.
Since Shaina was going through her first pregnancy, it was a difficult decision to decide for termination of pregnancy. But putting the best interest of the mother first it was duly decided that the mother be given the first priority.
Dr Shilva shares, “Although a decision was taken for the termination of pregnancy, our emergency team still believed in keeping hopes alive. Caesarean was done in a view of a poor bishop score, and after transfusing 2 units of platelets rich plasma, a healthy male baby weighing 3.4 kg was delivered. After operation her condition was stable; and blood pressure was controlled with due medicines. Around 48 hours of after operation, platelet improved to 96000 and liver enzymes showed declining trend. Shaina was discharged on 5th post-operative day with her child. Such a case is an amazing example of super specialty doctors working together to save lives.”