**9. HELLP syndrome**

Hemolysis, elevated liver enzymes and low platelets (HELLP) Syndrome often arises following preeclampsia. However, in 20% of the women, HELLP Syndrome may be the first presentation of preeclampsia. Women often present with acute right upper quadrant or epigastric pain. They may also have other preeclampsia stigmata that include headaches, vomiting, visual disturbances, irritability and altered consciousness. Systemic examination may reveal raised blood pressure. Abdominal examination might note epigastric pain or right upper quadrant tenderness. Investigation might depict hemolysis (raised lactate dehydrogenase >500 units/L; bilirubin >12 mg/L), raised liver enzymes (alanine transaminase >70 units/L) and low platelets. Management is aimed at stabilizing blood pressure, seizure prophylaxis, correction of any coagulation abnormality and delivery [8].
