RUQ pain following C-section (558/1700)

A 27yo woman had pre-eclampsia and was delivered by C-section. She is now complaining of
RUQ pain different from wound pain. What inv will you do immediately?

a. Coagulation profile
b. LFT
c. Liver US
d. MRCP
e. None



























answer: B

Presentation

• HELLP syndrome is a serious form of pre-eclampsia and patients may present at any time in the last half of pregnancy.
• One third of women with HELLP syndrome present shortly after delivery.
• Symptoms of HELLP syndrome are usually nonspecific.
• Initially, women may report nonspecific symptoms including malaise, fatigue, right upper quadrant or epigastric pain, nausea, vomiting, or flu-like symptoms.
• Hepatomegaly can occur.
• Some women may have easy bruising/purpura.
• On examination, oedema, hypertension and proteinuria are present.
• Tenderness over the liver can occur.

Investigations

• There needs to be a high index of clinical suspicion in order to avoid diagnostic delay and improve outcome.
• Haemolysis with fragmented red cells on the blood film
• Raised LDH >600 IU/L with a raised bilirubin.
• Liver enzymes are raised with an AST or ALT level of >70 IU/L.
• Levels of AST or ALT >150 IU/L are associated with increased maternal morbidity and mortality.