Approach

A diagnosis of pre-eclampsia should be made when there is persistent, new-onset hypertension usually with proteinuria after 20 weeks' gestation.[1][2][3][37] The absence of hypertension excludes the diagnosis, although there are related conditions, such as HELLP syndrome, that may present with and without hypertension. HELLP syndrome is a subtype of severe pre-eclampsia characterised by haemolysis (H), elevated liver enzymes (EL), and low platelets (LP).[2] The presence of proteinuria is no longer mandatory in the diagnosis of pre-eclampsia; systemic involvement or fetal growth restriction together with hypertension are enough to fulfil the diagnosis, even in the absence of proteinuria.[1][3] After diagnosis, fetal assessment should be performed with further maternal tests to assess systemic involvement.

If there are signs and symptoms of severe pre-eclampsia or complications, immediate treatment is needed. On confirmation of the diagnosis, or if there are concerns regarding maternal or fetal health, the woman should be admitted to an obstetric care facility for management.[1][2]

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