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HELLP 37 Weeks Immediate Delivery — ESENeph MCQ

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ModeratePregnancy & RenalHELLP 37 Weeks Immediate DeliveryESENeph

A 32-year-old woman at 37 weeks' gestation with known CKD G3a (eGFR 50 mL/min/1.73m2) develops new heavy proteinuria (uPCR 350 mg/mmol from baseline 45), BP 165/105 mmHg on labetalol and nifedipine, and epigastric pain. Platelets are 88 x 10^9/L, ALT 250 U/L, LDH 850 U/L. What is the most appropriate management?

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Correct answer: E — Stabilise the mother and expedite planned delivery

This patient has severe pre-eclampsia with features of HELLP syndrome (Haemolysis, Elevated Liver enzymes, Low Platelets) at 37 weeks. At ≥37 weeks, the management per NICE NG133 is immediate planned delivery — the only definitive treatment for pre-eclampsia. Magnesium sulphate should be given for seizure prophylaxis during/after delivery. Antihypertensives continue to prevent hypertensive complications during the delivery process. Renal biopsy is contraindicated in the setting of thrombocytopenia and coagulopathy. At 37 weeks, fetal maturity is adequate and there is no benefit to delaying delivery. Post-delivery monitoring for 72 hours is essential as HELLP can worsen initially before improving.

Reference: NICE 2019 – NG133 Hypertension in Pregnancy; RCOG 2022 – HELLP Management: https://ukkidney.org/health-professionals/guidelines/clinical-practice-guideline-pregnancy-and-renal-disease