Last reviewed: 29 Oct 2021
Last updated: 10 Mar 2021



History and exam

Key diagnostic factors

  • nausea/vomiting
  • hypertension
  • brisk tendon reflexes

Other diagnostic factors

  • right upper quadrant/epigastric pain and tenderness
  • generalized malaise
  • headache
  • edema
  • 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

  • CBC 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



James N. Martin, Jr, MD, FACOG, FAGOS, FAHA, F(H)RCOG

Professor Emeritus of Obstetrics, Gynecology, and Maternal-Fetal Medicine

University of Mississippi Medical Center




JNM Jr is an obstetrician-gynecologist and maternal-fetal medicine consultant to BlueCross & BlueShield of Mississippi and the Mississippi Perinatal Quality Collaborative. He is co-director of the Mississippi Maternal Mortality Review Committee. He serves on the Global Operations Advisory Group of the American College of Obstetricians and Gynecologists (ACOG), and in 2018-9 he chaired the ACOG Presidential Task Force on Pregnancy and Heart Disease. JNM Jr lectures, teaches, researches, and speaks nationally and internationally on the subjects of hypertensive complications of pregnancy, including HELLP syndrome. He is also the lead author and editor of "The 2015 compendium for HELLP syndrome: from bench to bedside" (Nova Biomedical Publishers). JNM Jr is an author of several references cited in this topic. He has cited his own papers 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

Jerome Yankowitz, MD

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.

Deirdre Murphy, MD, MRCOG

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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