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HELP

Wendy blogs from an MSF maternity hospital in Haiti about a patient who defied the odds

I've been working on the mortality review for September's medical report. Usually our mortality rate is pretty low, two or three women, but last month was significantly higher at ten. I haven't been able to identify a reason why; it seems to have been mostly an unlucky month for us.

One case sticks out for me, though, because she didn't die. She had severe pre-eclampsia, had had surgery, and remained in a coma for several days. Another patient with a very similar story had already passed away a few days previously. I was sure that this one would quickly follow suit. In the bed next to her was another woman who was very jaundiced, with HELLP syndrome, who, when I first saw her, was awake and alert but definitely yellow.

Two days later, I arrived to find the anaesthetists working on the patient with jaundice, who had had a cardiac arrest, from which she never recovered. But the one in a coma? She woke up. And the next day, she was sitting up and feeding herself. She was groggy but not complaining of any discomfort.

We don't have a way to prove intracranial pathology here, but with severe pre-eclampsia, she was at very high risk for cerebral hemorrhage, which generally has a bad outcome (like death). I assume from the fact that she woke up that she had not had a cerebral hemorrhage, but 'just' some swelling, which had resolved with the steroids she'd been prescribed, and time, and delivery of the pregnancy (which is the cure for pre-eclampsia).

HELLP syndrome is on the severe end of the spectrum of diseases related to pre-eclampsia. I think it's one of the best-named illnesses in medicine, for being doubly-descriptive. HELLP stands for Hemolysis, Elevated Liver enzymes, and Low Platelets. It is a serious illness that requires attending to with some urgency. Patients with HELLP definitely need help.