CASE SCENARIO (HELLP SYNDROME)

Patient JSD is a 31-year-old Filipino female, born on June 27, 1990. She is a Roman Catholic
and currently resides at San Vicente Caluis, Concepcion, Tarlac. She is married to RSD for 5
years. Patient JSD works as a factory worker but stopped on her third trimester due to her
pregnancy. She cannot tolerate to stand for long and complains of back pain and edema was
noted in her hands, face and lower extremities. Thinking that this is normal during
pregnancy, she did not consult an OB.

There is no family history of asthma and DM, but hypertension runs in their family (father
side). Her father was diagnosed with stroke last 2016. Patient JSD has a history of
preeclampsia at 32 weeks on her previous pregnancy (2018) and underwent cesarean
section at Concepcion District Hospital.

1 day prior to admission, patient experienced continuous vomiting, accompanied by

epigastric pain, headache and blurry vision since afternoon. At 4 am the next day, they
went to Dr. Eutiquio L. Atanacio Jr. Memorial Hospital (DEAMHI) for admission.

Laboratory values were significant for elevated transaminases (alanine aminotransferase

(ALT): 694 units/L (U/L); aspartate aminotransferase (AST): 1028 U/L)), decreased platelet
counts (72 x 109/L), and elevated lactic acid dehydrogenase (LDH) (2082 U/L) consistent with
HELLP syndrome, for which she was admitted.

Admitting Diagnosis: PU 34 wks AOG, HELLP Syndrome

Upon admission at 4:50 am of October 11,2021, Patient JSD’s vital signs were as follows: BP:
180/120, HR: 102 bpm, O2 Sat: 98%, FHT: 140 bpm. She was ordered to undergo antigen
swab test to ensure that she is not COVID positive. CBC w/ platelet count and UA was also
ordered. She was temporarily instructed to keep nothing per orem. Vital signs were taken
every hour. For therapeutic management, D5LRS 1LX30 gtts/min was initiated. MgSO4 5g
each buttock was also administered as stat dose followed by MgSO4 drip of D5W 500 cc +
20g MgSO4 regulated at 50 microdrops/min via soluset. IFC was also inserted aseptically to
monitor for her urine output. Hydralazine 5 mg IV was also given as a stat dose and
metoclopramide IV.

At 10:43 am, the patient had vaginal spotting and DOB. Patient was hooked to O2 via NC at
2-3 LPM and Dexamethasone 8 mg IM was administered as a stat order. The doctor also
ordered that she is for possible CS within the day.

At 11:12 am, patient JSD had seizure for 3 minutes. Diazepam 1 amp IVP was administered
as per doctor’s order. Pre-op orders were also given as follows: *For stat CS *Secure consent
*NPO *Give Cefazolin 2g IV ( ) ANST *Abdminoperineal prep *Notify OR/Anesth/Pedia
*Secure 2 ‘u’ PRBC for possible OR use.

The patient was subsequently taken for emergency low transverse Cesarean section (LTCS)
which was performed without incident and transferred to Recovery Room postoperatively
for close monitoring. Patient JSD’s post op medications includes Cefazolin 1g IVP Q8 x 3
doses, Ranitidine 50 mg IVP Q8 x 3 doses, Ketorolac 30 mg IVP X 4 doses.

Postoperatively, she complained of some expected incisional pain but denied lower rib cage
or upper abdominal pain. She continued on combination IV magnesium/oxytocin, with
blood pressure readings in the 130s-150s/90s-100s range; an additional dose of IV labetalol
was given with improvement in blood pressure readings. She denied headaches, blurred
vision, double vision, substernal chest pain, palpitations, increased shortness of breath,
pleurisy, or recurrent nausea/vomiting. 

She remained in the OB ward for four days postoperatively. All labs continued to trend
towards normal, including her blood pressure. Her platelets improved to 117 x 10 9/L, and
liver function tests (LFTs) were slightly elevated, though trending towards normal (AST 38
U/L, ALT 147 U/L). She was discharged with nifedipine and labetalol for blood pressure
control. Her discharge precautions were to return if she experienced severe headaches,
dizzy spells, blurry vision, chest pain, upper abdominal pain, or blood pressures over 140/90.
The patient reported significant improvement in her clinical symptoms, continued to meet
her postoperative milestones, and was discharged with a follow-up visit scheduled in one
week for blood pressure monitoring and staple removal.