INTRODUCTION. HELLP syndrome represents the form of preeclampsia
characterized by moderate hypertension, often with absence of proteinuria and
oedema. The frequency of HELLP syndrome in pregnant women with preeclampsia
is 10-20%. The clinical course of the disease is characterized by the
progressive worsening of mother and fetus condition, which can be stopped
only by delivery. Disseminated intravascular coagulation is present in 8% of
patients with HELLP syndrome and causes significant morbidity and mortality.
CASE OUTLINE. We present a case of HELLP syndrome complicated by intrauterine
fetal demise and disseminated intravascular coagulation in trigemelar
pregnancy. After all surgical and medicamentous methods to establish
haemostasis were exhausted, the patient was treated by recombinant activated
factor VII (rFVIIa) in intravenous bolus dose of 90 ?g/kg twice, which
resulted in satisfactory haemostasis. Side effects of the drug were not
registered. CONCLUSION. The application of rFVIIa reduced haemorrhage in our
patient, both after the Caesarean section and after hysterectomy,
contributing to the patient?s full recovery, without neurological sequelae
and with preserved renal function. RFVIIa is not an alternative to surgical
haemostasis, but its administration should surely be considered before
deciding to perform hysterectomy, especially in patients who want to preserve
fertility. In cases of postpartum haemorrhage, when bleeding persists even
after adequate surgical haemostasis, the administration of rFVIIa is to be
considered not only as an alternative to hysterectomy, but also an effort to
prevent significant maternal morbidity and mortality.
Successful application of recombinant activated factor VII in a patient with HELLP syndrome and disseminated intravascular coagulation