Review Question - QID 104761

This patient is presenting with headache, hypertension, proteinuria, a low red blood cell count, elevated liver enzymes, and low platelets which is concerning for HELLP syndrome. The most effective treatment is to deliver the infant (cesarean section).

HELLP syndrome refers to hemolysis, elevated liver enzymes, and low platelets, and is often associated with preeclampsia. Patients typically present with nonspecific complaints such as malaise, epigastric pain, nausea, vomiting, and headache. The initial evaluation will demonstrate hypertension and proteinuria. Any patient presenting with HELLP syndrome should be given magnesium (to treat/prevent seizures), have their blood pressure controlled (with drugs like nifedipine or labetalol), and should have their coagulopathy corrected. The only definitive treatment is immediate delivery of the infant.

Incorrect Answers:
Answer 1: Betamethasone should be administered in this patient for fetal lung development while they are heading to the operating room for delivery; however, it is not the definitive treatment of HELLP syndrome.

Answer 3: Lorazepam is indicated in the management of status epilepticus; however, magnesium is preferred initially in the treatment of seizures in eclampsia/HELLP syndrome.

Answer 4: Magnesium is the preferred treatment for seizures in eclampsia and HELLP syndrome and this patient should be receiving magnesium; however, it is not the definitive treatment.

Answer 5: Platelet transfusion is only indicated if < 10,000/mm^3 or < 50,000/mm^3 and bleeding (or with planned C-section); however, it is not definitive treatment.

Bullet Summary:
The definitive management of HELLP syndrome is emergency delivery.