HELLP syndrome and HELLP-like syndrome in pregnancies with covid-19 – case reports


Authors: Čivrná J. 1;  Skanderová D. 2;  Ehrmann J. 2;  Pilka R. 3
Authors‘ workplace: Gynekologicko-porodnické oddělení, Nemocnice AGEL Šternberk 1;  Ústav klinické a molekulární patologie, LF UP a FN Olomouc 2;  Porodnicko-gynekologická klinika LF UP a FN Olomouc 3
Published in: Ceska Gynekol 2021; 86(4): 236-241
Category: Case Report
doi: 10.48095/cccg2021236

Overview

Objective: We present two case reports of severe course of covid-19 in pregnancy demonstrating similarity between covid-19 and HELLP syndrome. Case report: The first case report describes an asymptomatic course of covid-19 accompanied by elevation of liver enzymes and lactate dehydrogenase but low ratio of angiogenic bio­markers. No severe pregnancy complication occurred. All laboratory results had normalized after recovering from covid-19. The second case report describes a patient with elevated liver enzymes and lactate dehydrogenase which preceded a respiratory failure. Furthermore, one of the most feared complication of pregnancy occurred, namely hepatic rupture. After a delivery, the condition of the patient had been improving only slowly. It is not clear whether this condition represented a severe course of covid-19 or a concurrence of covid-19 and HELLP syndrome. Conclusion: A severe course of covid-19 in pregnancy may cause a dia­gnostic dilemma for its similarity between covid-19 and a specific complication of pregnancy – HELLP syndrome. This might lead to an unnecessary intervention and iatrogenic prematurity or underestimation of symptoms and delayed dia­gnosis of HELLP syndrome.

Keywords:

HELLP syndrome – COVID-19 – HELLP-like syndrome


Sources

1. Zhou F, Yu T, Du R et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395 (10229): 1054–1062. doi: 10.1016/S0140-6736 (20) 30566-3.

2. Mendoza M, Garcia-Ruiz I, Maiz N et al. Preeclampsia-like syndrome induced by severe COVID-19: a prospective observational study. BJOG 2020; 127 (11): 1374–1380. doi: 10.1111/1471-0528.16339.

3. Figueras F, LLurba E, Martinez-Portilla R et al. COVID-19 causing HELLP-like syndrome in preg­nancy and role of angiogenic factors for differential dia­gnosis. 2020 [online]. Avail­able from: https: //www.medrxiv.org/content/ 10.1101/2020.07.10.20133801v1.

4. Šimetka O, Vlk R, Procházka M. HELLP syndrom. In: Vlk R, Procházka M, Měchurová A et al. Preeklampsie. Od patofyziologie ke klinické praxi. Praha: Maxdorf Jessenius 2015: 251–254.

5. Futterman I, Toaff M, Navi L et al. COVID-19 and HELLP: overlapping clinical pictures in two gravid patients. AJP Rep 2020; 10 (2): e179–e182. doi: 10.1055/s-0040-1712978.

6. Roubalová L, Vojtěch J, Feyereisl J et al. Screening preeklampsie v I. trimestru těhotenství. Ceska Gynekol 2019; 84 (5): 361–370.

7. Cerdeira AS, Karumanchi SA. Angiogenic factors in preeclampsia and related disorders. Cold Spring Harb Perspect Med 2012; 2 (11): a006585. doi: 10.1101/cshperspect.a006585.

8. Herraiz I, Simón E, Gómez-Arriaga PI et al. Angiogenesis-related bio­markers (sFlt-1/ /PLGF) in the prediction and dia­gnosis of placental dysfunction: an approach for clinical integration. Int J Mol Sci 2015; 16 (8): 19009–19026. doi: 10.3390/ijms160819009.

9. Bubeníková Š, Cíchová A, Roubalová L et al. Využití poměru koncentrací solubilního receptoru tyrozinkinázového typu 1 a placentárního růstového faktoru pro krátkodobou predikci a dia­gnostiku preeklampsie. Ceska Gynekol 2016; 81 (4): 272–278.

10. MacSween RN, Anthony PP, Schever PJ et al. Pathology of the liver. 3rd ed. Londýn: Churchill Livingstone 1994.

11. Součková M, Pilka R, Malý T et al. HELLP syndrom komplikovaný rupturou jater – kazuistika. Ceska Gynekol 2014; 79 (3): 219–225.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

Article was published in

Czech Gynaecology

Issue 4

2021 Issue 4

Most read in this issue
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account