Author(s): Ahmed Sherif Abdel Hamid*, Ayman Aly Hamed El-Sallamy
Aim: This case reports a patient of postpartum partial HELLP (hemolysis, elevated liver enzymes and low platelets) who manifested rectus sheath hematoma after 5 days of cesarean section (CS) and we shortly summarize HELLP syndrome, its diagnosis and treatment. Case: A pregnant woman (G2P1, 38 weeks) visited us due to headache and high blood pressure (BP) with urine protein 3+: with blood count, coagulation, and liver enzymes being normal. Cesarean section (CS) was performed, after which MgSo4 was administered. BP was stabilized; then, post-CS day 2, platelets began to decrease with elevated lactate dehydrogenase with small drop of hemoglobin. Post-CS day 3, drop of hemoglobin, decreased platelets count and elevated LDH were observed, which made us diagnose this condition as partial HELLP (liver enzymes were normal). Post-CS day 5, she complained of lower abdominal pain and bilateral lower abdominal swellings at site of CS scar. Ultrasound revealed bilateral rectus sheath hematoma, which was confirmed by CT. Hb was 8.7 gm/dl, so 2 units of packed RBCs were transferred. She was kept on triple antibiotics together with antihypertensive drugs and was discharged 12th day post-CS. Laboratory data returned normal, indicating resolution of partial HELLP syndrome. Three months post-CS, hematoma disappeared. Conclusion: Obstetricians must be aware that HELLP/partial HELLP can occur after successful CS and rectus sheath hematoma can manifest.