HELLP Syndrome Before Viability: A Case of Successful Expectant Management [ID 893]

INTRODUCTION: HELLP syndrome, defined by hemolysis, elevated liver enzymes, and low platelet count, is a severe form of preeclampsia most commonly seen in the third trimester. Presentation before 20 weeks is extremely rare and can mimic other hepatic or hematologic disorders, delaying diagnosis and management. METHODS: A 26-year-old woman, gravida 2, para 1, presented at 18 weeks of gestation with fatigue, right upper quadrant pain, and nausea. She denied fever or hypertension. Physical examination was unremarkable. Laboratory testing revealed anemia (Hb 9.2 g/dL), thrombocytopenia (platelets 78,000/microliter), elevated liver enzymes (AST 212 U/L, ALT 180 U/L), and elevated LDH. Viral hepatitis panel, autoimmune screen, and tests for thrombotic microangiopathies were negative. Obstetric ultrasound confirmed a viable singleton pregnancy with normal biometry and fluid. Based on the Mississippi classification, a diagnosis of class 2 HELLP syndrome was made. Informed patient consent was obtained for publication of the case report. RESULTS: The patient was hospitalized for observation and received supportive management with corticosteroids and close maternal–fetal monitoring. Over the following days, liver enzymes and platelet count stabilized. She continued antenatal care and delivered at 36 weeks by cesarean section for fetal growth restriction. The neonate had appropriate Apgar scores and no complications. CONCLUSIONS/IMPLICATIONS: Although HELLP syndrome is rare before 20 weeks, it should be included in the differential diagnosis of early gestational hepatic dysfunction. Early recognition and multidisciplinary care are key to optimizing maternal and fetal outcomes.