HELLP syndrome and HELLP-like syndrome in pregnancies with covid-19 – case reports

Summary: Objective: We present two case reports of severe course of covid-19 in pregnancy demonstrating similarity between covid-19 and HELLP syndrome. Case report: The fi rst case report describes an asymptomatic course of covid-19 accompanied by elevation of liver enzymes and lactate dehydrogenase but low ratio of angiogenic bio markers. No severe pregnancy complication occurred. All laboratory results had normalized after recovering from covid-19. The second case report describes a patient with elevated liver enzymes and lactate dehydrogenase which preceded a respiratory failure. Furthermore, one of the most feared complication of pregnancy occurred, namely hepatic rupture. After a delivery, the condition of the patient had been improving only slowly. It is not clear whether this condition represented a severe course of covid-19 or a concurrence of covid-19 and HELLP syndrome. Conclusion: A severe course of covid-19 in pregnancy may cause a diagnostic dilemma for its similarity between covid-19 and a specific complication of pregnancy – HELLP syndrome. This might lead to an unnecessary intervention and iatrogenic prematurity or underestimation of symptoms and delayed diagnosis of HELLP syndrome.