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

J, Čivrná; D, Skanderová; J, Ehrmann; R, Pilka

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 first 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 dia-gnostic 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 dia-gnosis of HELLP syndrome.