Co-existence of hypertensive urgency and hemolysis elevated liver enzymes and low platelets syndrome in a parturient with myasthenia gravis: a therapeutic challenge

Nivedita Jha, Divya Bhukya, Shruthi Shreenivas Subhedhar, Sasirekha Rengaraj, Haritha Sagili, Veena P.


Hemolysis elevated liver enzymes and low platelets (HELLP syndrome) is an obstetric emergency developed in the settings of hypertensive disorder of pregnancy and it is associated with a heightened risk of adverse fetomaternal outcomes. Obstetric and anaesthetic management is indeed challenging in HELLP syndrome. The presence of myasthenia gravis further complicates the managements issues in these women. Here, in this report, we describe a 35 years G2P1L1 known case of myasthenia gravis, who presented in emergency with uncontrolled hypertension, imminent eclampsia and HELLP syndrome at 29+1 weeks of gestation. Antihypertensive medication included hydralazine, alpha methyldopa, infusions of labetolol and nitroglycerine. She underwent successful vaginal delivery using fentanyl as labour analgesia. Prompt decision making using multidisciplinary team appeared vital in controlling the hypertension adequately and quickly without aggravating myasthenic crisis.


HELLP syndrome, Myasthenia gravis, Pregnancy, Preeclampsia, Multidisciplinary approach

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