CASE STUDY OF HELLP

I. Patient

Name: Arquizal, Flordeliza S.

Age: 40 yrs. Old

Sex: Female

Address: P. Mangga Kigay, Malangas Zamboanga Sibugay

Date of Birth: 5-18-1978

Religion: Roman Catholic

Occupation: Housewife

II. ABSTRACT

The purpose of this case study is to identify HELLP syndrome exists as a distinct entity
or is part of a spectrum of pregnancy complications, which have in common hemolysis, elevated
liver enzymes, and thrombocytopenia, has long been a source of speculation and debate among
obstetricians and internists. A review of the literature indicates a definite need for a uniform
definition, diagnosis, and management of this syndrome. Patients manifesting this syndrome
usually are seen before term (less than 36 weeks' gestation) complaining of malaise (90%),
epigastric or right upper-quadrant pain (90%), and nausea or vomiting (50%), and some will have
nonspecific viral-syndrome-like symptoms. Hypertension and proteinuria may be absent or slight.
Thus some of these patients may have a variety of signs and symptoms, none of which are
diagnostic of classic preeclampsia. In consideration of the high maternal and perinatal mortality
and morbidity reported with the presence of this syndrome, I recommend that all pregnant women
having any of these symptoms should have a complete blood cell count with platelet and liver
enzyme determinations irrespective of maternal blood pressure.
 III. INTRODUCTION

HELLP syndrome is a life-threatening pregnancy complication usually considered to be a variant of

preeclampsia. Both conditions usually occur during the later stages of pregnancy, or sometimes after
childbirth.

HELLP syndrome was named by Dr. Louis Weinstein in 1982 after its characteristics:

H (hemolysis, which is the breaking down of red blood cells)

EL (elevated liver enzymes)
LP (low platelet count)
HELLP syndrome can be difficult to diagnose, especially when high blood pressure and protein in the
urine aren't present. Its symptoms are sometimes mistaken for gastritis, flu, acute hepatitis, gall bladder
disease, or other conditions.

The global mortality rate of HELLP syndrome has been reported to be as high as 25%. That's why it's
critical for expecting mothers to be aware of the condition and its symptoms so they can receive early
diagnosis and treatment.

A. Symptoms of HELLP Syndrome

The physical symptoms of HELLP Syndrome may seem at first like preeclampsia. Pregnant women
developing HELLP syndrome have reported experiencing one or more of these symptoms:

 Headache
 Nausea/vomiting/indigestion with pain after eating
 Abdominal or chest tenderness and upper right upper side pain (from liver distention)
 Shoulder pain or pain when breathing deeply
 Bleeding
 Changes in vision
 Swelling

B. Signs to look for include:

 High blood pressure

 Protein in the urine
The most common reasons for mothers to become critically ill or die are liver rupture or stroke (cerebral
edema or cerebral hemorrhage). These can usually be prevented when caught in time. If you or someone
you know has any of these symptoms, please see a healthcare provider immediately.

C. Risk of Getting HELLP in Future Pregnancies

Women with a history of HELLP syndrome are at increased risk of all forms of preeclampsia in
subsequent pregnancies. The rate of preeclampsia in subsequent pregnancies ranges from 16 to 52%, with
higher rates if the onset of HELLP syndrome was in the second trimester. The rate of recurrent HELLP
syndrome ranges from 2 to 19% depending upon the patient population studied.
IV. PATIENT HISTORY

a. Demographic Data

Mrs. Arquizal, Flordeliza a 40 years old housewife a multigravida mother,

married a resident at Purok Mangga, Kigay, Malangas, Zamboanga del sur with
her husband Mr. Arquizal Rey. She was born in March 18, 1978. The patient was
admitted at Margosatubig Regional Hospital with a chief complaint of epigastric
pain for 15 hours prior to consultation she was admitted at September 13, 2018.

b. Socio- Economic Status

Mrs. Arquizal was born in her hometown, a plain housewife while her husband a
farmer and living with seven children. She dropped at elementary level due to
financial problem. She married at the age of 19. Two of her children are already
married while the rest are living under her care, all of her children delivered at
home with trained hilot. She was raised as Roman Catholic, were she learned
about religious values when it comes in health matter, she seeks for quack doctor
and use herbal medicine to treat any members of the family who has an ailment
but when medical complication arise she seeks medical help.

c. Environmental Factors

Mrs. Arquizal lives in Purok Mangga, Kigay, Malangas Zamboanga Sibugay

together with her husband. The location of their home is not accessible from the
hospital but their health center is near at their home during her times of
pregnancy, she is busy handling in housework and caring of her children.
 ASSESSMENT

SKIN

 Brown and Fair Skin

 Skin Temperature within normal range ( 36.5c )

 Moist skin folds

 Nails with smooth texture

 Capillary refill time 2 seconds

 Bipedal Edema Noted

HEAD

 Absence of nodules or masses

 Symmetric facial features and movements

 Symmetric nasolabial folds

 Evenly distributed black hair

 No infestations

EYES

 Eyebrows symmetrically aligned with equal movements

 Eyelashes equally distributed and curled slightly outward

 Lids close symmetrically

 Bilateral blinking exhibited

EARS

 Color same as facial skin

  Symmetrically aligned

 Pinna Immediately recoils after it is folded

 No lesions or discoloration

 Dry Cerumen

 Able to hear ticking of watch in both ears

NOSE

 Symmetric and straight

 No discharge or flaring

 Absence of lesions and tenderness

 Nasal Septum intact and in the midline

MOUTH AND THROAT

 Outer lips uniform pink color with symmetric contour, soft and moist

 Buccal Mucosa is of uniform pink color

 Gums are pink with no bleeding noted

 Tongue pink, moist and central position

NECK

 Head Centered

 Lymph nodes not palpable

BREAST

 Firm

 Generally symmetric in size

  Areola rounded and the same shape

 Nipples round, everted and equal in size

 Milk Letdown

CARDIOVASCULAR

 BP 180/100 mmHg

 Symmetric Pulse Strength

 No Heart Murmur

RESPIRATORY/CHEST

 Chest Symmetric

 Chest Wall Intact, No Tenderness, No Masses

 Clear Breath Sounds

 Full symmetric chest expansion and excursion

GASTROINTESTINAL/ABDOMEN

 Tender because of suture from cesarean section

 Abdominal Contracted

 No bleeding noted at Suture Site

 Striae Present at hypogastric and iliac regions

URINARY

 Blood Tinged Urine

REPRODUCTIVE
  Regular Menstrual Cycle

 G8 P7

MUSCULOSKELETAL/EXTREMITIES

 Muscle equal size on both sides of the body

 Smooth Coordinated movements

 Edema noted at both extremities