Team care saves mother with trio of postpartum complications
Surgery, targeted treatment after aHUS diagnosis aid woman's recovery
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A 39-year-old woman who developed a rare sequence of postpartum complications — eclampsia, HELLP syndrome, and pregnancy-associated atypical hemolytic uremic syndrome (aHUS) — recovered after doctors performed a series of emergency interventions, according to a case report from China.
Postpartum eclampsia is characterized by high blood pressure and excess protein in urine soon after childbirth. HELLP syndrome, which stands for Hemolysis, Elevated Liver enzymes, and Low Platelets, primarily affects the blood and liver.
Her recovery followed life-saving surgery to control a liver bleeding that arose as a rare complication of HELLP syndrome, and targeted treatment that was started once an aHUS diagnosis was confirmed as her symptoms continued to worsen.
“This report aims to increase awareness of this potentially fatal group of pregnancy-related complications and highlights how early recognition and team based care can save lives,” the researchers wrote.
The report, “Multidisciplinary management of concurrent postpartum eclampsia, HELLP syndrome, ruptured hepatic subcapsular hematoma, and atypical hemolytic uremic syndrome: a case report,” was published in BMC Pregnancy and Childbirth.
Pregnancy complications share early symptoms
aHUS is caused by abnormal activation of the complement system, a part of the immune system that normally helps the body fight infections and clear damaged cells. As a result, blood clots form in small vessels throughout the body, a process known as thrombotic microangiopathy (TMA).
As these clots build up, red blood cells are broken down — a process called hemolysis — as they squeeze past narrowed vessels. Platelets, the tiny cell fragments in the blood that help with clotting, drop as they’re used to form more clots, and blood flow to the kidneys can become reduced, leading to acute kidney failure.
Pregnancy can trigger aHUS episodes, and in rare cases where it appears alongside other severe pregnancy-related complications such as eclampsia and HELLP syndrome, diagnosis becomes especially challenging because these conditions have similar early symptoms. Yet distinguishing among them is essential, the researchers noted, because management strategies diverge significantly.
The researchers described the case of a woman who arrived at the hospital after delivering her baby in a private vehicle. She developed a series of postpartum complications, including aHUS, in a combination that the researchers said has not been previously reported.
The woman had a history of borderline hypertension (high blood pressure) during pregnancy and had also been diagnosed with gestational diabetes (high blood sugar that develops during pregnancy). When she was admitted to the hospital, her blood pressure was elevated, she had minimal vaginal bleeding, and she was alert and oriented.
Soon after, however, her blood pressure continued to rise, and she experienced seizures, leading doctors to diagnose postpartum eclampsia. She was given magnesium sulfate to control the seizures. Blood tests then showed low platelet counts.
Later that night, her condition suddenly worsened. She was thirsty, and her blood pressure fell sharply. Her hemoglobin had dropped to a critically low value, indicating severe anemia. An ultrasound revealed a large amount of blood inside her abdomen, confirming severe internal bleeding.
Doctors immediately activated an emergency procedure used to replace large amounts of blood very quickly and rushed her to emergency surgery.
“A multidisciplinary team (obstetrics, general surgery, and anesthesiology) was mobilized immediately,” the researchers wrote.
During surgery, doctors found extensive bleeding on the surface of the liver, consistent with a ruptured subcapsular hematoma, a serious liver complication associated with HELLP syndrome.
Although the woman’s bleeding could be controlled and she was on comprehensive monitoring, her laboratory results continued to worsen. Her platelet count fell further, signs of hemolysis and TMA persisted, and markers of liver injury were significantly elevated. She then developed acute kidney failure that required continuous dialysis, a treatment in which a machine temporarily replaces the kidneys’ function of filtering waste from the blood.
Further testing showed abnormal complement system activation, which, combined with her kidney failure and the exclusion of other disorders, confirmed pregnancy-associated aHUS.
Doctors gave her a corticosteroid and intravenous (into-the-vein) immunoglobulin to reduce inflammation, along with six sessions of plasma exchange. Plasma exchange is a procedure in which the plasma, the acellular portion of the blood, is removed through a machine to clear harmful substances and then replaced with donor plasma.
Her platelets began rising about two weeks after surgery, and her kidney function normalized about three weeks later. By discharge on day 40 post-surgery, the woman’s organ impairments had largely normalized, and imaging in the following months showed the liver hematoma had nearly resolved.
“This rare and severe case illustrates a life-threatening sequence of postpartum complications and provides key insights for clinicians,” the researchers wrote. They stressed that when persistent or new blood clots in blood vessels are seen beyond 72 hours after childbirth, clinicians must quickly consider alternative diagnoses such as pregnancy-associated aHUS.
“Early complement testing and multidisciplinary escalation (including plasma exchange) are vital for survival in such multi-organ failure situations,” the researchers wrote.
