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+The 31-year-old white primipara with twin pregnancy was admitted to hospital in the 38th week of gestation with elevated blood pressure (150/100 mmHg).
+After receiving antihypertensive treatment blood pressure was 120/80.
+All laboratory variables, including plasma proteins, were within their respective reference intervals.
+Few hours after admission to the hospital the contractions started, and the caesarean section was performed because of vertex-transverse presentation of twins.
+Liveborn female and male were delivered.
+The postoperative course was initially inconspicuous.
+Four hours postpartum she experienced sudden epigastric pain.
+The blood pressure rose to 190/130.
+Laboratory findings showed haemolysis, thrombocytopenia, and an increase in serum creatinine and aminotransferases (Table I).
+Intravenous magnesium sulphate was administered.
+Abdominal ultrasound disclosed an empty uterine cavity without placenta residue.
+Five hours postpartum, the patient was transferred to the intensive care unit because of poor urine output, drowsiness, and suspicion of DIC.
+On examination she was sleepy and disoriented.
+The combination of haemolysis, thrombocytopenia, and elevated liver enzymes suggested a postpartum HELLP syndrome, complicated by DIC.
+The patient was rehydrated, and treatment was instituted with fresh frozen plasma, red cell transfusion, fresh platelets, and kybernin P (antithrombin III).
+High serum urea, creatinine, and persistent anuria were compatible with acute renal failure.
+A high dose of furosemide failed to increase diuresis.
+Sixteen hours postpartum her blood pressure was 60/40 and oxygen saturation 70%.
+Few minutes later the patient had acute cardiac arrest, and resuscitation started.
+Resuscitation was successful, and normal heart action was re-established; blood pressure rose to 150/110, and oxygen saturation was 90%.
+Laboratory findings were deteriorated, and development of acute renal failure indicated the necessity of urgent dialysis.
+Following dialysis, the patient was stable, oxygen saturation 98%.
+Twenty hours postpartum patient developed again cardiopulmonary arrest.
+Despite resuscitation attempts the outcome was lethal.
+Due to the fact that death occurred in the hospital a short time after a surgical intervention, a medico-legal autopsy was ordered.
+An autopsy revealed oedema of the brain and lungs as well as dilatation of right and left ventricles.
+Hydrothorax (900 mL), hydroperitoneum (2500 mL), and hydropericardium (200 mL) were present.
+The field of operation of the caesarean section was unremarkable.
+Petechial and suffusional haemorrhages were observed under the pleura, endocardium, in the mucosae of the renal pelvis, and peritoneum of the small and large bowel.
+Histology revealed periportal hepatocellular necrosis, bloodless glomeruli with swollen and vacuolated intracapillary cells, as well as confluent haemorrhages in kidneys, liver, and spleen.
+Death was attributed to multiple organ failure due to DIC as a consequence of HELLP syndrome.