By Dimity McCracken
These are images from real ICU patients.
A 23yo woman 34/40 gestation in her first pregnancy presented with nausea & progressive epigastric pain. She says “everyone at home has had gastro.”
Her pregnancy had been unremarkable up until this time.
Does this make you worried? How would you investigate this patient? How would you treat her?
Yes, this is concerning. We need to exclude possible HELLP syndrome.
Initial simple investigations include:
-Hypertension may be quite mild
-Hepatomegaly may be difficult to feel due to gravid uterus
-Always check for hyper-reflexia!!
-Urinalysis for proteinuria: remember absence of proteinuria does not exclude pre-eclampsia or HELLP.
-Baseline bloods, including LFT’s, platelet count (looking for thrombocytopaenia), haemolytic screen, uric acid, renal function, & coagulation profile (a percentage of HELLP patients develop DIC)
If findings are consistent with HELLP, then treatment is delivery of baby & supportive cares for mother.
This woman did have HELLP. She went for an emergency caesarean section, & delivered a healthy boy.
Her post-op CT scan shows massive hepatic haemorrhage. She had a long ICU stay for complications relating to hepatic dysfunction due to the sheer size of her haemorrhage, but eventually went on to make a full recovery.
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Ciantar & Walker present an interesting review on pre-eclampsia & HELLP (including a nice summary of treatment at the end)