Background:
HELLP syndrome is a serious obstetric condition that can be life-threatening to both mother and fetus. It is defined by haemolysis, elevated liver enzymes and low platelets. (1) While clinical presentation varies, typical symptoms include epigastric or right upper quadrant pain with nausea and vomiting, headache, swelling and visual disturbance. (2) Hypertension typically precedes HELLP syndrome, though in atypical cases it may present after biochemical derangement. (3)
Aim: To present a case of HELLP with atypical presentation.
Method: A review of clinical and laboratory findings.
Results:
A 30-year-old female, G2P1 at 37+5 weeks gestation presented with sudden onset tearing epigastric and left upper quadrant pain, following a two day gastroenteritis-like illness. Associated symptoms included headache, blurred vision and pedal oedema.
Severe hypertension of 172/100 was noted on arrival, requiring IV labetalol and hydralazine to control. Examination revealed left upper quadrant tenderness, brisk lower limb reflexes and pitting pedal oedema.
HELLP syndrome was diagnosed due to refractory hypertension, proteinuria and transaminitis. This was followed by thrombocytopenia and rapid anaemia with haemolytic features. This deterioration in bloods prompted commencement of magnesium sulfate, and delivery by emergency caesarean section.
Conclusion:
Atypical aspects of this case were that HELLP syndrome was not preceded by gestational hypertension or pre-eclampsia, and that the patient experienced predominantly left upper quadrant pain which resolved with analgesia. Apart from obesity, she had no risk factors for developing HELLP. This case report highlights that HELLP syndrome should always be considered in pregnant patients with any upper abdominal pain.