Atypical HELLP Syndrome in a Hydatidiform Molar Pregnancy: A Case Report

HELLP syndrome is a serious complication in pregnancy characterized by hemolysis, elevated liver enzymes and low platelet count [1]. First named by Weinstein in 1982, HELLP syndrome is a very serious manifestation of elevated blood pressure and proteinuria in pregnancy. Among pregnant women in the United States, approximately 5-8% will develop preeclampsia. Of those women, 15% will develop HELLP syndrome [2]. As many as 48,000 women per year will develop HELLP in the United States. The pathophysiology of HELLP syndrome is still not well defined. Several theories suggest that HELLP is a progression of preeclampsia. Others believe that HELLP syndrome is an entity of its own. Although the cause of HELLP syndrome is unknown, certain risk factors, including a maternal age of older than 34 years, multiparity, and European descent, have been described [3]. HELLP syndrome typically occurs between week 27 of gestation and delivery, or immediately postpartum in 15%30% of cases [3]. The typical patient with HELLP syndrome will present with signs or symptoms similar to preeclampsia such as elevated blood pressure, uncontrolled headache, visual disturbances, and/or hyperreflexia. However, HELLP syndrome may also result in more serious complaints such as right upper quadrant or epigastric pain suggestive of liver involvement. The initial evaluation of HELLP syndrome often includes laboratory work up with a complete blood count, comprehensive metabolic panel, lactate dehydrogenase level, uric acid level, and urinalysis. The serum transaminase levels may be elevated to as high as 4,000 U per L, but milder elevations are typical. Platelet counts can drop to as low as 6,000 per mm3, but any platelet count less than 150 per mm3 warrants attention [4]. Once the diagnosis of HELLP syndrome has been established, the best markers to follow are the maternal lactate dehydrogenase level and the maternal platelet count [5]. Laboratory abnormalities typically worsen after delivery and peak at 24 to 48 hours postpartum [5].