TRIPLET PREGNANCY WITH HELLP-SYNDROME AND TRANSIENT DIABETES-INSIPIDUS

A 35 year old primigravida with a triplet pregnancy developed polyuria and epigastric pain in the 31st week of pregnancy. During that week, emergency cesarean section was performed due to evidence of liver dise ase and imminent fetal hypoxia. Three girls were delivered who were he althy apart from transient neonatal respiration distress syndrome. Fol lowing surgery, the mother developed HELLP syndrome with hemolysis, in creased transaminases and thrombocytopenia. She also developed diabete s insipidus with daily urine outputs of up to 7000 ml and poor respons e to desmopression. Both the HELLP syndrome and the diabetes insipidus resolved spontaneously within ten days. In pregnant patients with rig ht upper quadrant pain, HELLP syndrome or acute fatty liver of pregnan cy should be considered. The association of diabetes insipidus with ac ute fatty liver of pregnancy is an established, but rare phenomenon. A s far as is known, this is the first report of a patient presenting wi th a combination of HELLP syndrome and diabetes insipidus. Patients wi th HELLP syndrome have a good prognosis, if the diagnosis is early and the pregnancy terminated at the right time. With close supervision fu rther pregnancies are possible.