Clinical example of management and delivery of a pregnant woman with HELLP syndrome

Background. The incidence of HELLP syndrome over the past decade has not decreased, making a significant contribution to maternal and perinatal morbidity and mortality. As a rule, bleeding as a result of DIC is the cause of maternal mortality in this case. Radical treatment is emergency delivery, leading to an increase in the frequency of preterm birth and not always improving the condition of the woman in the short term. To reduce the likelihood of uterine bleeding in such patients, the authors proposed to use the prophylactic compression sutures on the uterus during operative delivery. Description of the clinical case. The 33-years-old pregnant patient with a gestational age of 34 weeks, twins after in vitro fertilization, complained of epigastric pain. The criteria for the diagnosis of HELLP syndrome included laboratory data: hemolysis, thrombocytopenia over time, lactate dehydrogenase, indirect bilirubin, aspartate aminotransferase, alanine aminotransferase blood levels, proteinuria. Taking into account the development of HELLP syndrome, the patient was delivered in an urgent order by caesarean section under endotracheal anesthesia. In order to prevent bleeding, B-Lynch compression suture and 2 circular sutures were put on the body of the uterus. Stabilization of the patient’s condition after delivery occurred by the 4th day. During this time, she received antihypertensive, magnesial, antibacterial therapy, transfusion of platelet concentrate, erythrocyte suspension, fresh frozen plasma, glucocorticoid therapy, and from 3rd day - low-molecular heparins to prevent thromboembolic complications. 10 days after admission, the main laboratory parameters returned to normal values, and the patient was discharged in a satisfactory condition home. Conclusion. Preventive compression sutures on the uterus can reduce blood loss during and after delivery and thus break the vicious circle: massive blood loss - compensatory infusion of fluid - risk of pulmonary edema, and increase the likelihood of a favorable outcome for the woman, while preserving her reproductive function.

HELLP syndrome, massive blood loss, pregnancy, compression sutures, preeclampsia, blood-saving technologies