Tan A, Ma J, Deng X, Tang G
Clin Exp Obstet Gynecol. 2015;42(5):685-7.
Previous studies show that HELLP syndrome occurring in postpartum period was more dangerous to both fetus and the mother than if presented before delivery. So far, there is a lack of screening or predictive tests for postpartum HELLP syndrome in clinical practice.
Here the authors report a rare case of postpartum HELLP syndrome with severe ascites as the primary symptom. The patient was diagnosed with severe preeclampsia and fetal growth retardation at 34+2 weeks gestation and received anti-hypertensive therapy. Severe ascites were found intraoperatively during emergency caesarean section. On the second postoperative day, complete HELLP syndrome was diagnosed. This case gradually complicated by hypoproteinemia, acute renal failure, severe anaemia, and infection and required renal haemodialysis, blood transfusion, and other supportive treatments for about one month.
Although this case has a fulminant and long course, it has a well clinical prognosis and also shows that severe ascites may be a clue for postpartum HELLP syndrome in patient with severe preeclampsia.
既往研究表明，产后发生的HELLP综合征对胎儿和母亲的危险性均高于分娩前出现该综合征的情况。目前在临床实践中，缺乏针对产后HELLP综合征的筛查或预测性检测。
本文作者报告了一例罕见的以严重腹水为主要症状的产后HELLP综合征病例。该患者在妊娠34 + 2周时被诊断为重度子痫前期和胎儿生长受限，并接受了抗高血压治疗。在急诊剖宫产术中发现严重腹水。术后第二天，确诊为完全性HELLP综合征。该病例逐渐并发低蛋白血症、急性肾衰竭、严重贫血和感染，需要进行肾脏血液透析、输血及其他支持治疗约一个月。
尽管该病例病情凶险且病程较长，但临床预后良好，同时也表明严重腹水可能是重度子痫前期患者产后发生HELLP综合征的一个线索。
