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

Czech version

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: https://doi.org/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.