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HELLP Syndrome Complicated with Ascites during Third Trimester of Pregnancy – Therapeutic Management
Hypertensive disorders represent some of the most common medical complications during pregnancy, but it can lead to severe complications, among which the HELLP syndrome is one of the most serious. HELLP syndrome is a rare disease that affects pregnant women and approximately 0.2-0.6% of all births.
It is considered to be a severe form of preeclampsia occurring during either the third trimester of pregnancy or the postpartum period. Approximately 4-12% of the women diagnosed with preeclampsia will develop HELLP syndrome. HELLP syndrome may affect patients as a singular disease, or it may be associated with preeclampsia. This medical condition was described for the first time in 1982, by Dr. Louis Weinstein, as distinctive from preeclampsia.
We report here the case of a 25 year old patient, 37 weeks pregnant, who was admitted to “Elena Doamna” Clinical Hospital of Obstetrics and Gynecology, Iasi, Romania, for uterine contractions, spontaneous ruptured membranes, lower-extremity edema, high blood pressure (180/115 mm Hg), and a large amount of ascitic fluid.
In order not to endanger the life of the pregnant woman and her fetus, emergency cesarian delivery was performed. Intrapartum, 3.5 Liters (L) of ascetic fluid were extracted, which were sent to the laboratory for additional investigations, along with the placenta. Postoperative abdominal drainage consisted in a total of 8.5 L of fluid within a six day period.
After a thorough clinical examination associated with the laboratory results, the presumptive diagnosis of HELLP syndrome is suspected. The patient is compatible with the profile due to the risk factors, clinical examination, laboratory results and complications she developed during the hospitalization, all of these being specific for this syndrome. During admission, several complications affected the patient’s status, but they have been all overcome by collaborating with other specialties.
Keywords: pregnancy, ascitic fluid, gestational hypertension, preeclampsia, HELLP syndrome