View source for WBR0171

{{WBRQuestion
|QuestionAuthor={{Rim}} {{AJL}} {{Alison}}
|ExamType=USMLE Step 1
|MainCategory=Pathology
|SubCategory=Reproductive
|MainCategory=Pathology
|SubCategory=Reproductive
|MainCategory=Pathology
|SubCategory=Reproductive
|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Reproductive
|MainCategory=Pathology
|SubCategory=Reproductive
|MainCategory=Pathology
|SubCategory=Reproductive
|MainCategory=Pathology
|SubCategory=Reproductive
|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Reproductive
|Prompt=At 34 weeks of gestation, a 38-year-old female, G3P2A0, presents to the ER with complaints of severe nausea and a dull pain in her right upper abdomen. Her medical history is significant for preeclampsia. Upon appropriate work-up you observe elevated ALT, AST, and LDH levels, thrombocytopenia, and low haptoglobin levels. You inform the patient that immediate delivery is recommended. Given this patient's condition, which of the following is the most likely cause of mortality?
|Explanation= The patient in this condition is most likely presenting with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. [[HELLP syndrome]], considered a life-threatening form of [[preeclampsia]], is associated with [[preeclampsia]] and typically manifests in pregnant women between 32-34 weeks of gestation. Patients with [[HELLP syndrome]] typically present with right upper abdominal pain and with non-specific symptoms, such as fatigue and nausea. A serum haptoglobin test is crucial for the detection of early hemolysis. Usually, an elevation of the liver enzymes precedes the decrease in platelets. Patients are usually recommended to deliver promptly, when diagnosed at 32-34 weeks. The most common causes of mortality in patients with [[HELLP syndrome]] are [[intracranial hemorrhage]] and [[ARDS]].

|EducationalObjectives= Intracranial hemorrhage and ARDS are the most common causes of mortality in patients with HELLP syndrome.

|References= Rath W, Faridi A, Dudenhausen JW. HELLP syndrome. J Perinat Med. 2000;28(4):249-60.

|AnswerA=GI bleeding
|AnswerAExp=GI bleeding is not a common cause of mortality in patients with [[HELLP syndrome]].
|AnswerB=Myocardial infarction
|AnswerBExp=Myocardial infarction is not a very common cause of mortality in patients with [[HELLP syndrome]].
|AnswerC=Uterine bleeding
|AnswerCExp=Uterine bleeding is not a common cause of mortality in patients with [[HELLP syndrome]]. [[Uterine atony]] is a common cause of uterine bleeding, post-delivery, that may be fatal.
|AnswerD=Hematologic malignancy
|AnswerDExp=[[Hematologic malignancies]], such as lymphomas and leukemias, are not a common cause of mortality in patients with [[HELLP syndrome]].
|AnswerE=Intracranial hemorrhage
|AnswerEExp=An [[intracranial hemorrhage]] is a common cause of death in patients with HELLP syndrome.
|RightAnswer=E
|WBRKeyword=intracranial, cerebral, hemorrhage, stroke, cause, of, mortality, death, pregnancy, pregnant, HELLP, syndrome, preeclampsia, pre-eclampsia, eclampsia, hypertension, high, blood, pressure, fatigue, nausea, right, abdominal, pain, upper, hemolysis, haptoglobin, LDH, low, platelet, platelets, thrombocytopenia, elevated, high, increase, increased, liver, enzyme, enzymes, AST, ALT, SGOT, SGPT
|Approved=Yes
}}