PREECLAMPSIA AND LIVER INFARCTION IN EARLY-PREGNANCY ASSOCIATED WITH THE ANTIPHOSPHOLIPID SYNDROME

Background: Usually, preeclampsia is a disease of the second half of p regnancy (ie, beyond 20 weeks' gestation). Early-onset preeclampsia ha s been reported in association with the antiphospholipid syndrome; how ever, the cases reported have been at 25-30 weeks' gestation. Cases: T hree pregnant women presented with clinical and laboratory features of severe preeclampsia and the syndrome of hemolysis, elevated liver enz ymes, and low platelets (HELLP) before 20 weeks' gestation. On evaluat ion, they were found to have antiphospholipid antibodies (anticardioli pin and/or lupus anticoagulant). Two of the patients had abdominal com puted tomography scans that showed a low-density area along the hepati c periphery, compatible with hepatic infarction. Spontaneous resolutio n of all clinical and laboratory manifestations of preeclampsia and HE LLP syndrome was observed after fetal death and pregnancy termination. Conclusion: Preeclampsia and HELLP syndrome can present before 20 wee ks' gestation in association with the antiphospholipid syndrome and ma y be associated with hepatic infarction.