一位33週孕婦以突發性頭痛為表現，併發產後HELLP症候群

A 33-week Pregnant Woman Presented with a sudden Headache and Complicated Bypostpartum HELLP Syndrome

臨床上，妊娠期高血壓併頭痛是產科常見的問題之一，但若演變成子癇前症（Preeclampsia）、子癇症（Eclampsia）及HELLP症候群（HELLP syndrome）包括溶血（Hemolysis, H）、肝酵素升高（Elevated Liver enzymes, EL）和低血小板計數（Low Platelet count, LP），對孕婦及胎兒的影響則非常巨大。本案例是一位31歲妊娠約33+2週的女性個案，因突發性頭痛、腹痛合併少量陰道出血求治，被診斷為子癇前症，隨後併發胎盤早期剝離造成胎兒窘迫，須立即終止妊娠，經緊急剖腹順利產下一名女嬰，隔日追蹤全血球計數，顯示血小板突降，進而追蹤生化血檢查，發現肝功能惡化，所幸經支持療法，血壓控制得宜、肝指數下降及血小板回復正常，病況穩定順利出院。HELLP症候群是子癇前症的併發症大多發生於妊娠期，致死率高，文獻上指出極少數於產後發生，身為臨床第一線的我們，即使個案產後也應該要提高警覺，嚴密的監控血壓與症狀，快速診斷，早期介入治療，並排除其他內科原因，以保護母體安全。

 

Clinically, gestational hypertension complicated by headaches is common in Obstetrics. However, it may cause severe impacts on pregnant women and fetuses if it evolves into preeclampsia, eclampsia and HELLP syndrome that characterized by hemolysis, elevated liver enzymes, and a low platelet count. The case in this study is a thirty-one-year-old pregnant woman with 33+2 weeks of gestation, who was diagnosed with preeclampsia due to a sudden headache, abdominal pain and a small amount of vaginal bleeding. Subsequent abruptio placenta led to fetal distress so her pregnancy was terminated.A baby girl was successfully delivered by emergency caesarean section. The next day, the complete blood count showed a sudden drop in platelets. A biochemical blood test found that liver function deteriorated. After supportive therapy, blood pressure was well-controlled, liver index decreased and platelets level returned to normal. Eventually the patient recovered and discharged. HELLP syndrome is a complication of preeclampsia that mostly occurs during pregnancy and has a high fatality rate.Postpartum HELLP syndrome is rare. Frontline medical staff should be vigilant even in postpartum period. By close monitoring of blood pressure and related symptoms, early diagnosis and treatment could be prescribed to protect the mother’s safety.