A Maternal Mortality in the Case of HELLP Syndrome: An Avertable Loss

HELLP syndrome refers to haemolysis (H), elevated liver enzymes (EL) and low platelet count (LP) which is a group of clinical manifestations seen in preeclampsia and eclampsia. It is a life threatening obstetrical complication with high mortality rate. We aimed to present the characteristic autopsy findings associated with HELLP syndrome.

A 32-year-old multigravida in the third trimester of pregnancy, which had seizures and collapsed at home. Two days prior to her demise, she complained of abdominal pain and went to a clinic. Abdominal ultrasound was done and she was allowed home as there was no indication of labour.

At autopsy, petechial haemorrhages were seen in the internal organs namely the lungs, liver, stomach and intestines. Confluent haemorrhages were observed in the lungs and liver parenchyma. Placental abruption was also noted. These findings were consistent with disseminated intravascular coagulopathy (DIVC). The heart was mildly enlarged. The right ventricle was markedly thin and mostly composed of fat. The pathology is known as arrhythmogenic right ventricular cardiomyopathy (ARVC). Examination of the reproductive system showed a grossly normal foetus with estimated gestational age of 33 to 35 weeks.

Although the course of the disease is sudden and fulminant, the symptom such as severe abdominal pain should serve as a warning sign of the syndrome. Early detection of liver rupture may help to save the lives of both mother and foetus.