Case Report Hellp Syndrome
Case Report Hellp Syndrome
Case Report Hellp Syndrome
INTRODUCTION
SECTION II
CASE
I.
II.
Identity
Name
: Mrs. E
Age
: 29 years old
Address
:Mekarwangi
Ethnic
: Sunda
Religion
: Moslem
Education
: Junior High School
Job
: Housewife
Date of Admission
: August,17th 2016
Anamnesis
A. Chief Complaint
The patient came to hospital due to pain at pit of the stomach since 6
hours before admission to the hospital.
B. History of Present Illness
The patient came to hospital on August, 17 th 2016 due pain at pit of the
stomach since 6 hours before admission to the hospital. The patient
also complain pain during urinate and the color of her urine became
red 8 hours before admission. The patient also complain that she felt
dizziness and the fetus movement has been feel.
C. History of Past Illness
History of Hypertension
History of Diabetes Mellitus
History of Allergy
History of Hematologic Disease
History of Urinary tract/Kidney Disease
History of Trauma
History of Surgery
D. History of Family Illness
History of Hypertension
History of Diabetes Mellitus
History of Allergy
E. Menstrual Cycle
Age of Menarche : 14 years old
: denied
: denied
: denied
: denied
: denied
: denied
: denied
: denied
: denied
: denied
Gender
Male
This Pregnancy
Age
9 years
38-39
Labor History
Midwife
Years
2007
2016
weeks
III.
Physical Examination
A. General Status
General Condition
Level of Consciousness
Vital Signs
o Blood Pressure
o Heart Rate
o Respiraatory Rate
o Temperature
o Body Weight
o Body Height
B. General Examination
Mata
o Anemic conjunctiva
o Icteric sclera
o Pupil
o Light reflex
Thorax
o Cardiac
o Pulmo
o Mammae
o Palpation
(+)
o Percussion
o Auscultation
Extremities
o Edema
o Physiologic reflex
o Pathologic reflex
Obstetri examination
Leopold Maneuver
Leopold I
: buttock
Leopold II
Leopold III
: Head
Leopold IV
: convergent, 5/5
Vaginal toucher
IV.
Inspection
Palpation
Inspeculo
:
: blood (+)
: portio thick and soft
: -V/V: fluxus (-), fluor (-)
- Portio: mass (-), fluxus (+),
lateration (-)
Internal
Vaginal
Examination
:
Hematology
August,
August,
August,
August,
Unit
Normal
22.08
13.1
21,100
11.3
10,300
39
146,000
32
67,000
4.0
91
32
35
3.6
89
32
36
Value
08.27
2016
11.9
14,300
16.47
7.5
20,100
34
56,000
21
42,000
3.8
89
32
36
2.4
88
31
36
g/dL
/L
12-14
4,000-
%
/L
10,000
37-47
150,000-
juta/L
fL
pg
g/dL
450,000
3.8-5.2
80-100
26-34
32-36
Laboratory Test
Complete Urine
Color
Results
Unit
Normal range
Dark
Yellow
Clarity
Protein
yellow
Turbid
Pos
(++
Clear
Negatif
Erytrosit
+/500)
Pos
(++
Negatif
+/500)
Urine Microscopic
Eritrosit
35-40
<3
Clinical
August,
August,
Unit
Normal
Chemistry
Blood
17th 2016
88
18th 2016
97
mg/dL
Value
<140
Glucose
Liver Function
AST
418.8
250
U/I
<31
(SGOT)
ALT
115
U/I
<32
DUPLO
144
(SGPT)
DUPLO
Kidney Function
Urea
30.2
Creatinine
0.53
Electrolyte
Natrium
135
Kalium
4.4
Calcium
7.4
Cloride
108
48
0.77
mg/dL
mg/dL
15-36
0.52-1.04
130
4.7
8.4
100
mmol/L
mmol/L
mg/dL
mmol/l
137-150
3.5-5.5
8-10.4
94-108
Result
2.00
7.30
Unit
minute
minute
Normal value
1-3
5 - 15
V.
Result
Non reaktif
Normal Value
Non Reaktif
Resume
Mrs. E, 29 years old came to hospital due pain at pitch of the
stomach since 6 hours before admission to the hospital. The patient also
complain pain during urinate and the color of her urine became red 8 hours
before admission, dizziness and the fetus movement has been feel.
The examination found that the patient with moderate illness
appearance, vital sign when she came to the hospital show severe
preeclampsia. The physical examination has show there are pain and
tenderness at pitch of the stomach. Obstetrical examination has show
fundal height 27 cm and the fetal heart rate was 138 beats per minute. The
laboratory studies show anemic condition, thrombocytopenia and elevated
of liver enzymes.
VI.
Diagnosis
G2P1A0, 29 years old, gravid 38-39 weeks, with HELLP Syndrome.
VII.
Therapy
August,
17th 10.15
2016 06.45
RL+MgSO4
Metildopa
21.40
RL 500 cc + RL
MgSO4 20%
10 gr
Dopamet 3x2
Nifedipine
August,
MgSO4
20% 10 gr
2016 05.30
RL
Dopamet
O2
Dopamet
3x2
Nifedipine 3x1
18th
3x2
Nifedipine
2x1
3x1
FHT: 143x/m
VT: v/v no abnormalities, portio thick
and thin 4cm, fetal membrane +,
IX.
Follow Up
BP: 160/100
HR: 84
RR: 22
T: 36.2
LI: buttock, fundal height 27 cm
LII: back on the mother right side, FHR: 138 x/m
LIII: head
LIV: convergent
PD: v/v no abnormality, portio thick and thin, d 1 cm, fetal membrane +, head
presentation
HPHT: 15-11-15 TP: 28-08-2016
Lab: Ht 13,1 Leu: 21,10 Ht: 39 Trom: 146.000
UL: protein +3 CTG reaktif
Mrs. E 29 years old gravida aterm + severe pre-eclampsia
- Observation of general condition and vital sign
- Given informed consent to the family about mother and her
A
P
baby
head presentation H1
Leopold I: Fundal height: 27 cm
Leopold II: back at the left of mother side
Leopold III: head
Leopold IV: divergent
Mrs. E 29 years old G2P1A0 parturien aterm kala 1 latent phase + severe pre-
eclampsia.
GA: moderate ill appearance
BP: 160/100
HR: 84 x/m
RR: 21 x/m
T: 36C
FHR: 140 x/m
contraction: rare
dr. Ariefs advice: observation of FHR and contraction
Mrs. E 29 years old G2P1A0 parturien aterm kala 1 active phase + severe pre-
eclampsia
Observation general appearance + vital sign
Observation fetal heart rate
Dr. Ariefs advice: observation contraction and labor progress
Informed consent to the family about condition of mother and her baby.
Take blood sample
Given dopamet
O2 +, infuse +, DC +
Mrs. E 29 years old G2P1A0 parturien aterm kala 1 active phase + PEB
Observation general appearance and vital sign
Observation labor progress
Drip oxytocin 20 gtt
dr. Ismus advice: re-infeormed consent
transamin 3x1 amp
dexamethasone 3x1 amp
termination with drip oxytoscin 20 gtt
A
P
minimal
Observation GA, vital sign, bleeding
Consult to Internist: dr. Faris, Sp.PD
Bleeding: minimal
Mrs. E 29 years old P 2A0 partus matures per vaginam + HELLP syndrome +
anemia
Observation GA and vital sign
Observation bleeding: 50 cc
Bleeding: +/N
Mrs. E 29 years old P2A0 partus matures per vaginam with HELLP Syndrome
+ anemia
Observation GA and vital sign
Blood transfusion
Give therapy appropriate schedule
SECTION III
CASE ANALYSIS
Problems:
1. How to diagnose HELLP Syndrome from this case?
2. How is the management for this patient?
3. What are complications of HELLP Syndrome?
1. How to diagnose HELLP Syndrome from this case?
The term HELLP syndrome is used to describe preeclampsia in association
with hemolysis, elevated liver enzyme levels, and low platelet count. It is found in
about 10% of pregnancies complicated by severe preeclampsia. The diagnosis is
not always clear, and the syndrome may be confused with other medical
conditions. Any patient diagnosed with HELLP syndrome should be considered to
have severe preeclampsia. In the past, the diagnostic criteria for HELLP syndrome
were variable and led to inconsistent diagnoses. The newer criteria used for the
diagnosis of HELLP syndrome are those reported by Sibai and include specific
Theory
Symptoms:
In this case
Symptoms:
Headache
Nausea/vomiting/indisgesation
stomach
(epigastric pain)
Dizziness
Physical examinations:
-
BP 160/100
breathing deeply
Laboratory examinations:
Bleeding
- Hematocrit
Changes in vision
- Eritosit
Malaise
- Thrombosit
Swelling
- AST
Physical examinations:
Hypertension
Tachycardia
Tachypnea
- ALT
Laboratory examinations:
Hemolysis
Abnormal peripheral smear
LDH >600 U/L
Bilirubin >1.2 mg/dL
Elevated liver enzymes
Serum AST >70 U/L
LDH >600 U/L
Low platelets
Platelet count <100,000/mm3
hepatomegaly and referred pain from the phrenic nerve. Pain to the pericardium,
peritoneum, pleura, shoulder, gallbladder, and esophagus are consistent with
referred pain from the phrenic nerve. Confirmation of the diagnosis can be made
by computed tomography, ultrasonography, or magnetic resonance imaging.
Conservative management in a hemodynamically stable patient with an
unruptured subcapsular hematoma is an appropriate plan, provided that close
hemodynamic monitoring, serial evaluations of coagulation profiles, and serial
evaluation of hematoma status by radiologic studies are performed. If the patient
decompensates hemodynamically, the diagnosis of ruptured subcapsular
hematoma should be considered.
Postpartum management of the patient with HELLP should include close
hemodynamic monitoring for at least 48 hours. Serial laboratory evaluations
should be done to monitor for worsening abnormalities. Most patients will show
reversal of laboratory parameters within 48 hours postpartum.
3.
Nifedipine 3x1
Dopamet 3x2
Transfusion PRC
with HELLP syndrome of whom 40 percent had adverse outcome including two
maternal deaths. The incidence of subcapsular liver hematoma was 1.6 percent,
eclampsia 6 percent, placental abruption 10 percent, acute kidney injury 5 percent
and pulmonary edema 10 percent. Other serious complication included stroke,
coagulopathy, acute respiratory distress syndrome and sepsis.
Preference:
1.
2.
Gibbs, Ronald S.; Karlan, Beth Y.; Haney, Arthur F.; Nygaard, Ingrid E.
Danforths Obstetrics and Gynecology 10th Edition. California : Lippincott
Williams & Wilkins; 2008.
3.
Dutta DC, Konar H. DC Duttas textbook of Obstetrics 8th ed. New Delhi:
Jaypee Brothers Medical Publisher; 2015.
4.