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.