Constipation in obstetrics - an underrated sign

An interesting case of normotensive hemolysis, elevated liver function tests, and low platelet counts (HELLP) syndrome with only presenting symptom of severe constipation near term; an occult sign of liver disease. She presented in active labour with mild jaundice and early signs of disseminated intravascular coagulation (DIC). This was an obstetric near miss, as it was a fine balancing act combined with aggressive monitoring and nursing management by highly skilled team of trained obstetric nurse midwives. This was a humbling lesson which reminded us not to ignore aggravated commonly occurring symptom in all patients of obstetrics. Availability of fresh whole blood makes it easier to manage such cases as fresh components are extremely difficult to procure and process in remote obstetric units.