Pre-Eclampsia and HELLP Syndrome (Haemolysis, Elevated Liver Enzymes, Low Platelets)
| Element | Comment |
|---|---|
| Risk factors | First pregnancy, multiple pregnancy, family history, medical conditions such as renal disease |
| Symptoms | Headache, epigastric or right upper quadrant pain, oedema of face or limbs |
| Examination findings | Blood pressure >140/90 mmHg, proteinuria either dipstick ≥1+, urinary protein:creatinine ratio >30 mg/mmol, or 24-h urinary protein >300 mg, oedema, RUQ/epigastric discomfort, hyperreflexia (NB: hypertension and proteinuria may be absent in HELLP syndrome) |
| Blood tests | Pre-eclampsia: raised uric acid, mild elevation in transaminases, mild elevation in creatinine HELLP (all or some): haemolysis (reduced Hb, increased reticulocytes, reduced haptoglobins, fragments on blood film), low platelets, raised transaminases +/- bilirubin, renal impairment, elevated LDH |
| Markers of severity | BP: SBP >160 mmHg or DBP >110 mmHg CNS: Seizures, visual disturbance, severe headache or >3 beats clonus Hepatic: RUQ/epigastric pain, nausea/vomiting, transaminases > twice ULN CVS: pulmonary oedema Renal: creatinine >100umol/L; urine output <10 mL/h |