A 27yo woman had pre-eclampsia and was delivered by C-section. She is now complaining of
RUQ pain different from wound pain. What inv will you do immediately?
a. Coagulation profile
b. LFT
c. Liver US
d. MRCP
e. None
answer: B
Presentation
HELLP syndrome is a serious form of pre-eclampsia and patients may present at any time in the last half of pregnancy.
One third of women with HELLP syndrome present shortly after delivery.
Symptoms of HELLP syndrome are usually nonspecific.
Initially, women may report nonspecific symptoms including malaise, fatigue, right upper quadrant or epigastric pain, nausea, vomiting, or flu-like symptoms.
Hepatomegaly can occur.
Some women may have easy bruising/purpura.
On examination, oedema, hypertension and proteinuria are present.
Tenderness over the liver can occur.
Investigations
There needs to be a high index of clinical suspicion in order to avoid diagnostic delay and improve outcome.
Haemolysis with fragmented red cells on the blood film
Raised LDH >600 IU/L with a raised bilirubin.
Liver enzymes are raised with an AST or ALT level of >70 IU/L.
Levels of AST or ALT >150 IU/L are associated with increased maternal morbidity and mortality.