First Trimester Hemolysis, Elevated Liver Enzymes, Low Platelets Syndrome in a Surrogate Pregnancy

Abstract

Background The occurrence of hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome before 20 weeks of gestation is rare. HELLP is a possible but rare syndrome in gestational surrogate pregnancies for surrogates with risk factors for development of preeclampsia.

Case A 32-year-old patient with chronic hypertension and positive antinuclear antibody presented for prenatal care at 13 weeks and 1 day. She was a surrogate for the embryo of a 43-year-old couple. By 15 weeks she developed uncontrolled hypertension requiring hospitalization. She was expectantly managed until her condition deteriorated. At 16 weeks and 1 day she developed hemolysis, elevated liver enzymes, thrombocytopenia, and fetal demise.

Conclusions HELLP syndrome is rare and carries a significant morbidity and mortality for the mother and fetus. Clinicians should encourage the surrogate to share her medical history with the embryo donor for appropriate counseling on pregnancy risks.

Keywords

HELLP syndrome - previable - preeclampsia - gestational surrogate - in vitro fertilization

Note

There was no funding received for conducting this project.

• References

• 1 American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122 (5) 1122-1131
• 2 Bornstein E, Barnhard Y, Atkin R, Divon MY. HELLP syndrome: a rare, early presentation at 17 weeks of gestation. Obstet Gynecol 2007; 110 (2 Pt 2) 525-527
• 3 Sherer DM, Dalloul M, Stimphil R , et al. Acute onset of severe hemolysis, elevated liver enzymes, and low platelet count syndrome in a patient with a partial hydatidiform mole at 17 weeks gestation. Am J Perinatol 2006; 23 (3) 163-166
• 4 Stefos T, Plachouras N, Mari G, Cosmi E, Lolis D. A case of partial mole and atypical type I triploidy associated with severe HELLP syndrome at 18 weeks' gestation. Ultrasound Obstet Gynecol 2002; 20 (4) 403-404
• 5 Haram K, Trovik J, Sandset PM, Hordnes K. Severe syndrome of hemolysis, elevated liver enzymes and low platelets (HELLP) in the 18th week of pregnancy associated with the antiphospholipid-antibody syndrome. Acta Obstet Gynecol Scand 2003; 82 (7) 679-680
• 6 McMahon LP, Smith J. The HELLP syndrome at 16 weeks gestation: possible association with the antiphospholipid syndrome. Aust N Z J Obstet Gynaecol 1997; 37 (3) 313-314
• 7 Shanis L, Jessmon P, Sinaii N, Armant DN, Stratton P. IVF and increased risk for preeclampsia revisited: a meta-analysis. Fertil Steril 2011; 96 (3) S181
• 8 Calhoun KC, Barnhart KT, Elovitz MA, Srinivas SK. Evaluating the Association between Assisted Conception and the Severity of Preeclampsia. ISRN Obstet Gynecol 2011; 2011: 928592
• 9 Marchand E, Poncelet C, Carbillon L, Pharisien I, Tigaizin A, Chanelles O. Is there more complications with pregnancies from the assisted reproductive technology than spontaneous pregnancies? A retrospective study over 6 years [in French]. J Gynecol Obstet Biol Reprod (Paris) 2011; 40 (6) 522-528
• 10 Silberstein T, Levy A, Harlev A, Saphier O, Sheiner E. Perinatal outcome of pregnancies following in vitro fertilization and ovulation induction. J Matern Fetal Neonatal Med 2014; 27 (13) 1316-1319
• 11 Farley DM, Grainger DA, Tjaden BL, Frazier LM, Maki JE. Use of a gestational carrier for a patient with recurrent adverse pregnancy outcomes from early onset severe pre-eclampsia. Fertil Steril 2007; 87 (1) 189.e1-189.e3
• 12 Ethics Committee of the American Society for Reproductive Medicine. Consideration of the gestational carrier: a committee opinion. Fertil Steril 2013; 99 (7) 1838-1841
• 13 Martin Jr JN, Rinehart BK, May WL, Magann EF, Terrone DA, Blake PG. The spectrum of severe preeclampsia: comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification. Am J Obstet Gynecol 1999; 180 (6 Pt 1): 1373-1384
• 14 Fitzpatrick KE, Hinshaw K, Kurinczuk JJ, Knight M. Risk factors, management, and outcomes of hemolysis, elevated liver enzymes, and low platelets syndrome and elevated liver enzymes, low platelets syndrome. Obstet Gynecol 2014; 123 (3) 618-627
• 15 Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol 2004; 103 (5 Pt 1): 981-991