Abstract
Unexpected rapid death after delivery due to HELLP syndrome (HS) may become the subject of a forensic expertise. Since this syndrome is rarely encountered in forensic pathology, our objective was to point to some specific findings which might present forensic aspects of HS. These include unexpectedness, suddenness and fulminant course of this syndrome, which may confuse physicians, and on the other hand these characteristics cast doubt on violent injury, diagnostic oversights or iatrogenic injuries. Absence of classical signs of preeclampsia and non-specific clinical symptoms cause considerable differential diagnostic problems leading to a diagnostic delay or initial wrong non-obstetric diagnosis. A definitive postmortem diagnosis of HS in questionable cases of maternal death and consecutive forensic expertise of suspected medical malpractice should be based on accepted laboratory criteria and characteristic histopathological alterations.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Weinstein L (1982) Syndrome of hemolysis, elevated liver enzymes, a low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol 142:159–167
Rath W, Faridi A, Dudenhausen JW (2000) HELLP syndrome. J Perinat Med 28:249–260
Sibai BM, Ramadan MK, Usta I, Salama M, Marcer BM, Fridman SA (1993) Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol 169:1000–1006
Martin JN Jr, Rinehart BK, May WL, Magann EF, Terrone DA, Blake PG (1999) The spectrum of severe preeclampsia: comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification. Am J Obstet Gynecol 180 :1374–1384
Tsokos M, Longauer F, Kardosová V, Gavel A, Anders S, Schulz F (2002) Maternal death in pregnancy from HELLP syndrome. A report of three medico-legal autopsy cases with special reference to distinctive histopathological alterations. Int J Legal Med 116:50–53
Gliemroth J, Knopp U, Kehler U, Felberbaum R, Nowak G (2000) HELLP syndrome with haemoglobin vasospasm. J Clin Neurosci 7:59–62
Gürel AS, Gürel H (1998) Early development of HELLP syndrome associated with eclampsia: a case report. Eur J Obstet Gynecol Reprod Biol 76:241–243
Vigil-De Gracia P (2001) Pregnancy complicated by pre-eclampsia–eclampsia with HELLP syndrome. Int J Obstet Gynecol 72:17–23
Esan K, Moneim T, Page IJ (1997) Postpartum HELLP syndrome after a normotensive pregnancy. Br J Gen Pract 47:441–442
Faridi A, Rath W (1996) Differential HELLP syndrome diagnosis. Z Geburtshilfe Neonatol 200:88–95
Peternoster DM, Stella A, Simioni P, Mussap M, Plebani M (1995) Coagulation and plasma fibronectin parameters in HELLP syndrome. Int J Obstet Gynecol 50:263–268
Terrone DA, Isler CM, May WL, Magann EF, Norman PF, Martin JN Jr (2000) Cardiopulmonary morbidity as a complication of severe preeclampsia HELLP syndrome. J Perinatol 2:78–81
Reck T, Bussenius-Kammerer M, Ott R, Müller V, Beinder E, Hohenberger W (2001) Surgical treatment of HELLP syndrome-associated liver rupture–an update. Eur J Obstet Gynecol Reprod Biol 99:57–65
Matsuda Y, Kodama Y, Maeda Y, Hatae M, Terao T (1994) Pregnancy complicated by liver dysfunction: possible pathogenesis of vasospasm. Obstet Gynecol 84:678–679
Sedláková I, Podholová M, Toner J (2003) Subcapsular hepatic hematoma. Int J Obstet Gynecol 81:299–300
Schneider H (1994) Liver pathology within the scope of HELLP syndrome. Arch Gynecol Obstet 255:S245–254
Yagmurdur MC, Agalar F, Daphan CE (2000) Spontaneous hepatic rupture in pregnancy. Eur J Emerg Med 7:75–76
Stevenson JT, Graham DJ (1995) Hepatic hemorrhage and HELLP syndrome: a surgeon’s perspective. Am Surg 61:756–760
Abraham KA, Connolly G, Farrell J, Walshe JJ (2001) The HELLP syndrome, a prospective study. Ren Fail 23:705–713
Boesen MP, Groenbeck L, Wåhlin A, Petersen KR (2003) Partial necrosis of cervix uteri as a complication to HELLP-syndrome. Eur J Obstet Gynecol Reprod Biol 108:230–231
Abraham KA, Kennelly M, Dorman AM, Walshe JJ (2003) Pathogenesis of acute renal failure associated with HELLP syndrome: a case report and review of the literature. Eur J Obstet Gynecol Reprod Biol 108:99–102
Ducroz B, Villemonteix P, Magnin G, Pourrat O (1990) The HELLP syndrome: is this a clinical form of thrombotic microangiopathy? J Gynecol Obstet Biol Reprod (Paris) 19:729–736
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Simic, M., Tasic, M., Stojiljkovic, G. et al. HELLP syndrome as a cause of unexpected rapid maternal death–A case report and review of the literature. Int J Legal Med 119, 103–106 (2005). https://doi.org/10.1007/s00414-004-0484-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00414-004-0484-x