HELLP syndrome

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A 28-year-old woman comes together with her partner to the Department of Gynaecology and Obstetrics at the local hospital. The woman is 26 weeks pregnant, presents with a strong and sudden epigastric pain and right upper quadrant tenderness. She describes the pain as dull and persistent. Furthermore, she complains of nausea, vomiting and severe headache. How do you proceed?

You take patient’s medical history, measure blood pressure, perform fetal ultrasound. Then you decide to hospitalise the patient for a couple of days. In case of high blood pressure, you administer antihypertensive medication, in case of persisting difficulties, especially lasting headache, you ask for a neurological consultation.

Wrong answer

Patient’s symptoms, such as a headache and epigastric pain, may indicate some very serious complications of pregnancy. Increased blood pressure corresponds with the headaches, but it does not explain the abdominal pain. It is necessary to perform further examination, including basic laboratory tests in order to determine the cause of problems.


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You prescribe painkillers to relieve the headache and recommend her to make an appointment with her gynaecologist 10 days from now.

Wrong answer

Patient’s symptoms, such as a headache and epigastric pain, may indicate some very serious complications of pregnancy. Any underestimation of her condition could have severe consequences for both mother and fetus. It is necessary to perform further examination, including basic laboratory tests, in order to determine the cause of problems.


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You take patient’s medical history, measure blood pressure, perform fetal ultrasound and CTG, take peripheral blood samples for laboratory testing and urine for chemical analysis.

Correct answer

Medical history always forms the basis for determining the diagnosis, blood pressure measurement belongs to the basic examination of every pregnant woman and so do the USG examination, CTG and laboratory tests. All of this will help us determine the underlying cause of the patient’s problems.

Fetal examination: USG - normal findings, corresponds with the gestational age of 25 4/7; CTG - physiological recording (regular fetal heartbeat, basal fetal heart rate of 140 bpm, no uterine contractions).


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You are probably dealing with gastroenteritis, the best solution is to perform fetal ultrasound and dispatch the patient to the Department of Gastroenterology for further examination.

Wrong answer

It is not possible to make the final diagnosis without having more information about patient's condition and its causes. Abdominal pain may indicate gastrointestinal upset, however, epigastric pain combined with a headache might be the symptoms of a much more serious complication. It is necessary to perform further examination, including basic laboratory tests in order to determine the cause of problems.


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Help

CTG - cardiotocography
USG - sonography
LDH - lactate dehydrogenase

Basic laboratory tests:
- full blood count, coagulation tests, electrolytes
- liver enzymes, LDH, total bilirubin
- uric acid, urea, creatinine
- total protein, albumin×
 
RR

18 bpm

HR

89 bpm

SpO2

not available

BP

159/112 mmHg

ECG

not available

Examination:
Physical Exam:
General: conscious, no apparent distress, oriented, cooperating
Skin: warm, pink, slightly sweaty
Pulm: clear to auscultation bilateraly
Cardiac: regular rate and rhythm, tachycardia 90 bpm
Abdomen: right upper quadrant tenderness
Extremities: no edema

Vaginal exam: normal findings; Cervix score: 0

Gly

not available

ABG

not available

CBC

not available

biochemistry

not available