Peripartum cardiomyopathy and HELLP syndrome in a previously healthy multiparous woman: A case report

Abstract

Peripartum cardiomyopathy is a type of dilated cardiomyopathy in which the exact etiology is uncertain. HELLP syndrome is characterized by a constellation of different clinical and laboratory findings, including hemolysis, elevated liver enzymes, and low platelets. Few case reports exist detailing successful diagnosis and management of postpartum HELLP syndrome, peripartum cardiomyopathy, and multisystem organ failure in a previously healthy woman. We herein report the case of a 39-year-old multiparous female with mild gestational hypertension, who presented in the third trimester with vaginal bleeding and was subsequently suspected to have intrapartum placental abruption leading to immediate Cesarean section, complicated by massive postpartum hemorrhage, necessitating care in the intensive care unit. HELLP syndrome, disseminated intravascular coagulation, and acute kidney injury requiring hemodialysis subsequently developed along with respiratory failure and peripartum cardiomyopathy. After diagnosis and proper management, the patient made a full recovery. Peripartum cardiomyopathy should remain on the differential for women with heart failure symptoms.

Variants of system and organ damage in patients with various thrombotic microangiopathy subtypes in obstetric practice

“…При ТМА Pregravid preparation and pregnancy кардиальная симптоматика часто остается недиагностированной вследствие отсутствия клинических симптомов. По данным мировой литературы, имеются описания дилатации полостей сердца у 37% женщин с ПЭ [23], признаки сердечной недостаточности в группе пациенток с ТМА по сравнению с контрольной группой [24], изолированное снижение фракции выброса у 21,7% в когорте из 49 пациенток с HELLP-синдромом [25], а также развитие перипартальной кардиомиопатии у пациенток с ТМА [26]. В одном случае на фоне дилатации полостей сердца у пациентки с ТМА был диагностирован инфаркт миокарда (без поражения крупных коронарных артерий) [27].…”

A Rare Case of HELLP Syndrome with Hematomas of Spleen and Liver, Eclampsia, Severe Hypertension and Prolonged Coagulopathy—A Case Report

“…Maternal mortality in HELLP is estimated at 1-25% [3,15]. Perinatal mortality of fetuses of mothers with this syndrome is estimated at 7-34% [15,16], and preterm birth affects about 70% of HELLP cases [17].…”