Search

HELLP syndrome is a multi-organ disorder unique to pregnancy. It is characterized by hemolysis, elevated liver enzymes, and low platelets in patients with pre-eclampsia or eclampsia. In King Abdulaziz Oncology Center, Jeddah, seven patients with HELLP syndrome were admitted over a period of four years (1991-94). Retrospective analysis of data was done to study the clinical profile of HELLP syndrome. The incidence of HELLP syndrome in our institution was 1 per 2285 deliveries. One patient was Saudi and six were non-Saudis. The age range was 23 to 44 years, with a mean of 29 years. All patients were multipara. The disorder occurred between 24 to 33 weeks of gestational age, the average being 29 weeks. The most commonly encountered clinical feature was right upper quadrant/epigastric pain. Other features included nausea/vomiting, jaundice, hepatic encephalopathy, azotemia, hypotension and grand mal convulsions. All patients had severe pre-eclampsia pr eclampsia. Indirect hyperbilirubinemia was in the range of 2 to 8 mg/dL and elevated transaminases up to 229 U/L (n<40 U/L) were noted. Various degrees of peripheral thrombocytopenia (<150x10(9)/L) were present in seven patients. Four patients had elevated prothrombin and partial thromboplastin time with postive fibrinogen degradation products. Laboratory abnormalities returned to normal within 10 days following delivery. Four patients were delivered by cesarean section and three had vaginal deliveries. We had two maternal deaths (mortality 34%). One died of multi-organ failure and the other with adult respiratory distress syndrome. There was one stillbirth and the second baby died soon after birth due to prematurity (infant perinatal mortality 34%). We conclude that HELLP syndrome is rare among pregnant women in our institution. It should always be suspected in women with pre-eclampsia or eclampsia when they present with upper abdominal pain. Multipara seem to be more afflicted. Subclinical disseminated intravascular coagulation was detected in 55% of the patients. A majority of our patients presented late to the hospital.

Ninety-nine patients with meningcoccal disease were admitted to the medical department of King Fahd Hospital, Medina during the Haj season of 1407H. (August 1987G). Neisseria meningitidis group A (Clone III-I) was responsible for this outbreak. This bacteria was brought into the Kingdom of Saudi Arabia by the pilgrims from South Asia who were carriers of the disease. Middle age and elderly seemed to be vulnerable to meningococcal disease. The majority of the patients presented with fever, headache, vomiting, skin rash, and signs of meningeal irritation. Diabetics afflicted with meningococcal disease fared badly; of 13 diabetics in the study, eight died. The mortality rate in our patients was 12.1%, a figure comparing favorably with other studies. The factors which influenced mortality included age above 50, shock, coma, renal failure, DIC, upper gastrointestinal bleeding, female sex and other associated diseases. The outbreak was successfully controlled by mass vaccination with polyvalent vaccine of the pilgrims and local population along with chemoprophylaxis with rifampicin.