Summary
Definition
History and exam
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
Contributors
Authors
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
Jackson
MI
Disclosures
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 reviewers
Professor and Director
Division of Maternal-Fetal Medicine
Department of Obstetrics and Gynecology
University of Iowa Hospitals and Clinics
Iowa City
IA
Disclosures
JY declares that he has no competing interests.
Professor of Obstetrics
Trinity College
University of Dublin
Consultant Obstetrician
Coombe Women and Infants University Hospital
Dublin
Ireland
Disclosures
DM declares that she has no competing interests.
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