The application of Mississippi Protocol in superimposed pre-eclampsia patients with class 2 hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome

HIGHLIGHTS The baby's outcome after pregnancy termination is premature, with low birth weight and respiratory distress. After the termination of the pregnancy, laboratory parameters begin to improve over time. Mississippi protocol therapy was continued 4 days post-termination of pregnancy until clinical and laboratory conditions improved. ABSTRACT Objective: To report the application of Mississippi Protocol (MP) in superimposed pre-eclampsia with class 2 HELLP syndrome. Case Report: The patient was initially treated conservatively with anticonvulsant prophylaxis, antihypertensives and high-dose corticosteroids, according to the MP. However, during observation, there was placental abruption and fetal distress. Thus a green code Sectio Cesarea (SC) was performed. This placental abruption is one of the complications that can occur in pre-eclampsia. The baby's outcome after pregnancy termination is premature, with low birth weight and respiratory distress. After the termination of the pregnancy, laboratory parameters begin to improve over time. MP therapy was continued 4 days post-termination of pregnancy until clinical and laboratory conditions improved. The rationale for giving high doses of corticosteroids in HELLP syndrome is that the syndrome has an excessive inflammatory response is the uniqueness of this case report. Corticosteroids are expected to prevent maternal morbidity and mortality and improve fetal outcomes. Conclusion: Monitoring and adequate management are mandatory in applying MP in patients. The definitive management of both pre-eclampsia and HELLP syndrome is the termination of pregnancy. Further study is needed to evaluate the efficacy of MP application in an emergency or complicated cases.