Last reviewed: 4 Feb 2021
Last updated: 04 Jan 2019



History and exam

Key diagnostic factors

  • nausea/vomiting
  • hypertension
  • brisk tendon reflexes

Other diagnostic factors

  • RUQ/epigastric pain and tenderness
  • generalised malaise
  • headache
  • oedema
  • visual disturbances
  • jaundice
  • bleeding

Risk factors

  • white ethnicity
  • maternal age >35 years
  • obesity
  • chronic hypertension
  • diabetes mellitus
  • autoimmune disorders
  • multiple gestation
  • abnormal placentation (e.g., molar pregnancy)
  • previous pregnancy with preeclampsia with/without HELLP syndrome

Diagnostic investigations

1st investigations to order

  • FBC with differential including platelets
  • peripheral blood smear
  • liver transaminases
  • bilirubin level
  • total serum LDH level
  • uric acid level
  • urinalysis and protein-to-creatinine ratio
  • PT/PTT
  • fibrinogen level
  • fetal ultrasound

Investigations to consider

  • serum glucose level
  • serum creatinine and electrolyte levels
  • antithrombin level
  • haptoglobin level
  • maternal upper abdomen ultrasound, CT, or MRI
  • lactate dehydrogenase (LDH)-to-aspartate aminotransferase (AST) ratio

Treatment algorithm


Professor of Obstetrics and Gynecology

Vice Chair for Research and Academic Development

Director of the Divisions of Maternal-Fetal Medicine and Research

University of Mississippi Medical Center




JNM Jr is a maternal-foetal medicine consultant and obstetrician gynaecologist to Mississippi Blue Cross Blue Shield and the Mississippi Perinatal Quality Collaborative. He is a member of several American Congress of Obstetricians and Gynecologists (ACOG) committees including the Global Operations Advisory Group, Compensation, and the Telehealth WorkGroup, chair of the ACOG 2018 Task Force on Pregnancy and Heart Disease, and a member of the International Federation of Gynecology and Obstetrics (FIGO) Non-communicable Diseases Committee. He is a teacher, lecturer, and speaker about HELLP syndrome for the ACOG, Federación LatinoAmericana de Sociedades de Obstetrícia y Ginecologia (FLASOG) and Mexican Federation of Colleges of Obstetrics and Gynecology (FEMECOG). JNM Jr is also an author of a number of references cited in this topic.

Dr James N. Martin Jr would like to gratefully acknowledge Dr Marium G. Holland and Dr Alex C. Vidaeff, the previous contributors to this topic. MGH declares that she has no competing interests. ACV is an author of a number of references cited in this topic.

Peer reviewersVIEW ALL

Professor and Director

Division of Maternal-Fetal Medicine

Department of Obstetrics and Gynecology

University of Iowa Hospitals and Clinics

Iowa City



JY declares that he has no competing interests.

Professor of Obstetrics

Trinity College

University of Dublin

Consultant Obstetrician

Coombe Women and Infants University Hospital




DM declares that she has no competing interests.

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