HELLP syndrome in the postpartum period complicated by bilateral serous retinal detachment

Introduction
HELLP syndrome is a life-threatening condition associated with pre-eclampsia or eclampsia. It occurs in women during pregnancy or, less frequently, in the postpartum period. The syndrome is characterized by hemolytic anemia, elevated hepatic enzyme levels, and thrombocytopenia, accompanied by arterial hypertension. A rare ocular complication of hypertensive disorders in pregnancy and the puerperium is bilateral serous retinal detachment.

Case description
A previously healthy 29-year-old woman at 39 weeks of gestation delivered a healthy infant via spontaneous vaginal delivery. The pregnancy had been uncomplicated. During labor, elevated blood pressure was noted and managed pharmacologically. Laboratory tests revealed thrombocytopenia, signs of hemolytic anemia, and elevated hepatic enzymes. Urinalysis confirmed proteinuria. These findings were consistent with HELLP syndrome secondary to pre-eclampsia. Approximately 2 hours postpartum, the patient reported bilateral blurred vision, which progressively worsened. Ophthalmological examination revealed bilateral serous retinal detachment involving the macula. Management included antihypertensive therapy, enforced bed rest, and systemic corticosteroids. Gradual improvement was observed over the following days. Complete reattachment of both retinas and full restoration of visual acuity were achieved five weeks postpartum.

Conclusions
Ocular symptoms reported by women during pregnancy or the puerperium should not be underestimated, as they may indicate serious systemic conditions that pose a threat not only to vision but also to maternal and fetal health.