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HELLP Syndrome at 20 Gestational Weeks Managed Using the Mississippi Protocol: A Case Report
Naohisa Masuko1, Kenji Tanimura1, Masayuki Tanaka1
1Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan.
The Kobe Journal of Medical Sciences
|April 21, 2024
Summary
Early, intensive treatment of Hemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome before 22 weeks of gestation, following the Mississippi protocol, can lead to successful pregnancy termination without maternal complications.
Area of Science:
- Perinatal Medicine
- Maternal-Fetal Medicine
- Obstetrics
Background:
- Hemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome is a severe complication of hypertensive disorders in pregnancy.
- HELLP syndrome before 22 gestational weeks (GWs) is exceptionally rare, often associated with maternal diseases or fetal abnormalities.
Observation:
- A 38-year-old pregnant woman presented at 19 + 5/7 GWs with hypertension, proteinuria, edema, and fetal growth restriction.
- She was diagnosed with partial HELLP syndrome at 20 + 2/7 GWs, without identifiable underlying maternal diseases or fetal abnormalities.
Findings:
- The patient was managed with the Mississippi protocol, including dexamethasone, magnesium sulfate, antihypertensives, and intensive monitoring.
- Additional treatments included platelet transfusion, haptoglobin infusion, and human atrial natriuretic peptide.
- The pregnancy concluded with an induced delivery at 20 + 3/7 GWs, with the mother discharged without complications.
Implications:
- This case suggests that the Mississippi protocol may facilitate uncomplicated pregnancy termination for early-onset HELLP syndrome.
- Early and intensive management is crucial for patients with HELLP syndrome before 22 GWs.
- Provides valuable insights for clinicians managing rare obstetric emergencies.
