A pregnant patient presents with right upper quadrant pain, malaise, elevated liver enzymes, and low platelets. What condition is suspected and what is typical management?

• A. HELLP syndrome; expedite delivery if maternal/fetal status deteriorates; monitor labs and coordinate with obstetric team.
• B. Eclampsia; manage with seizure precautions and magnesium sulfate.
• C. Acute fatty liver of pregnancy; monitor liver function and schedule delivery.
• D. Iron deficiency anemia; initiate iron therapy and nutrition counseling.

Answer: (B)

This presentation is most consistent with HELLP syndrome, a severe form of preeclampsia. The key clues are the combination of liver involvement and low platelets: elevated liver enzymes show hepatic stress, and thrombocytopenia is the “LP” part of HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets). RUQ pain often occurs with hepatic edema or subcapsular liver processes seen in HELLP. Malaise is a nonspecific but common symptom in this condition. Eclampsia would involve seizures, typically after preeclampsia develops, and acute fatty liver of pregnancy often presents similarly but usually with more pronounced liver dysfunction and sometimes hypoglycemia and coagulopathy; the presence of both liver enzyme elevation and low platelets without a described seizure pattern points more toward HELLP.

Management centers on delivering the placenta to stop the disease process, with stabilization as needed. If maternal or fetal status deteriorates, delivery should be expedited. In the interim, the team monitors labs (hemolysis markers, platelets, liver enzymes), controls blood pressure, and provides seizure prophylaxis with magnesium sulfate if there are preeclampsia features. Coordination with obstetrics is essential to determine timing and mode of delivery, taking gestational age and fetal status into account.