Educational Case: Hemolysis elevated liver enzymes and low platelets (HELLP syndrome)

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine

Background:

• Preeclampsia management guidelines emphasize comprehensive maternal and fetal assessment.
• Initial evaluation includes laboratory tests (CBC, platelets, creatinine, LDH, liver enzymes, proteinuria) and fetal ultrasound/antepartum testing.

Observation:

• Continued observation is recommended for preterm preeclampsia without severe features until 37 weeks gestation.
• Expectant management is contraindicated with severe hypertension, persistent headaches, epigastric pain, visual disturbances, altered sensorium, stroke, myocardial infarction, renal dysfunction, pulmonary edema, placental abruption, vaginal bleeding, eclampsia, or HELLP syndrome.

Findings:

• Management decisions are contingent upon evaluation results and gestational age.
• Specific severe features and complications dictate the need for immediate delivery versus continued observation.

Implications:

• This approach ensures timely intervention for severe preeclampsia while optimizing outcomes for eligible preterm cases.
• Accurate risk stratification is crucial for tailoring preeclampsia management strategies.