Atypical HELLP syndrome secondary to uteroplacental insufficiency

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Very little is known about atypical HELLP syndrome in relation to uteroplacental insufficiency. A 41-year-old primigravida with fetal growth restriction due to uteroplacental insufficiency suddenly experienced severe right upper quadrant pain at 28 weeks gestation without preeclampsia. Although laboratory abnormalities were not evident, the symptoms persisted for 2 hours. Elective cesarean section was performed because atypical HELLP syndrome was highly suspected. On postpartum day 1, a marked elevation of liver enzymes, low platelet count, and anemia without hypertension and proteinuria were noted, but these parameters spontaneously improved within a week. Our experience highlights instances where atypical HELLP syndrome might occur in uteroplacental insufficiency cases.