Fatal air embolism associated with HELLP syndrome following first-trimester pregnancy termination: An autopsy-based...

In forensic practice, sudden maternal deaths following obstetric procedures require meticulous postmortem investigation to establish the cause of death. Although pregnancy termination is generally considered a safe procedure, rare but potentially fatal complications may occur. Hemolysis, Elevated Liver enzymes, and Low Platelet count (HELLP) syndrome and venous air embolism are individually uncommon but life-threatening conditions. A 23-year-old woman (gravida 2, para 1) at 9 weeks and 6 days of gestation underwent an uncomplicated elective pregnancy termination following normal preoperative laboratory findings. Within a few hours after the procedure, she developed gastrointestinal symptoms, hypotension, rapidly progressive thrombocytopenia, elevated liver enzyme levels, and laboratory evidence of hemolysis. Despite intensive resuscitative efforts, she died. A meticulous medico-legal autopsy employing the underwater pericardial water-filling technique demonstrated abundant intracardiac air within the right ventricle, while the overall clinical and laboratory findings supported the diagnosis of HELLP syndrome. This case highlights the fatal coexistence of early-onset HELLP syndrome and venous air embolism following first-trimester pregnancy termination. It underscores the importance of comprehensive clinicopathological correlation and meticulous forensic autopsy in accurately determining the cause of unexplained maternal death.