Mixed connective tissue disease and HELLP syndrome in pregnancy

A 35-year-old woman (gravida 4, para 3) was known to have mixed connective tissue disease (MCTD-Sharp's syndrome) for five years, treated with immunosuppressives. She was in the 20 + 4 week of an unwanted pregnancy. On admission she had marked eclampsia with severe hypertension (180/130 mmHg), laboratory tests revealing hemolysis, elevated liver enzymes and thrombocytopenia, indicating an HELPP syndrome (severe eclampsia with hemolysis, elevated liver function and low platelets). The symptoms worsened over a few days, the patient initially having refused treatment. The fetus died in utero. After drug-induction of labor the fetus was ejected and with further supportive treatment the patient's condition rapidly improved. This patient developed HELPP syndrome in association with MCTD. There is no proof that the collagen disease had a causal or aggravating effect on the development of HELPP syndrome.