Go back


    Preeclampsia, Eclampsia & HELLP – Diagnosis

    Cardiovascular, Obstetrics and Gynecology, Special Populations

    Last Updated Feb 18, 2020
    Read Disclaimer


    • Preeclampsia is a disorder of widespread vascular endothelial malfunction and vasospasm.
      • Occurs > 20 weeks gestation and up to 6 weeks post partum.
      • Most often onset is close to term, while earlier presentations are more severe.
      • Preeclampsia = new onset hypertension with proteinuria (most often) or organ dysfunction.
      • Preeclampsia with severe features = preeclampsia complicated by severe hypertension or organ dysfunction.
    • Eclampsia = preeclampsia with new onset of seizures or coma.
    • HELLP Syndrome = severe pre-eclampsia variant defined by hemolysis, elevated liver enzymes and low platelet count.
    • Worldwide approximately 4.6% of pregnancies are complicated by preeclampsia.
    • Preeclampsia is a leading cause of maternal and fetal mortality and morbidity.
      • Maternal: seizures (eclampsia), stroke, liver dysfunction, pulmonary edema, renal failure, placental abruption.
      • Fetal: stillbirth, preterm or small for gestational age.
    • Risk factors: diabetes, hypertension, kidney disease, obesity, prior preeclampsia, nulliparity, multifetal pregnancy, autoimmune disease, maternal age <20 or >35 yrs.
    • Presentations: headache, visual disturbances, chest pain, shortness of breath, abdominal pain, nausea/vomiting, or acute edema of face, hands or lower extremities.

    Require admission, discharge at obstetrical direction.

    Diagnostic Process



    • Previously normotensive women after 20 weeks gestation, now with:
      • Systolic pressure ⩾140 mmHg or diastolic pressure ⩾90 mmHg, and proteinuria
      • Systolic pressure ⩾140 mmHg or diastolic pressure ⩾90 mmHg, and end organ dysfunction
    • Superimposed Preeclampsia = new onset/worsening of hypertension, proteinuria or end organ dysfunction in patients with preexisting hypertension and/or proteinuria
    • Proteinuria:
      • Urine Dipstick ⩾2+ Protein
      • Confirmation tests (not ED issue):
        • Protein:Creatinine ratio ⩾3omg/mmol
        • Proteinuria ⩾0.3g/d in a 24-hour urine collection
    • End organ dysfunction:
      • Thrombocytopenia: Platelet count <100,000/µL
      • Serum creatinine > 97.2 µmol/L or doubling, in the absence of other renal disease.
      • Liver transaminases 2X upper limit of the normal
      • Pulmonary edema
      • CNS:
        • Altered mental status
        • Visual changes
        • Hyperreflexia
        • Clonus
      • FHR abnormality

    Preeclampsia with Severe Features

    • Preeclampsia with ⩾ 160mmHg Systolic or ⩾110mmHg Diastolic, or if any end organ features are present.

    HELLP Syndrome

    • Variant of preeclampsia
    • NB: hypertension and proteinuria NOT required for diagnosis, although they are present in approximately 85% cases
    • Diagnosis requires all of:
    1. Hemolysis: LDH ⩾600 IU/L
    2. Elevated Liver Enzymes – AST or ALT > 2X upper limit of normal
    3. Low Platelets – Platelet count <100,000/µL
    4. Hemolysis can also be established by at least two of:
    • Peripheral smear with schistocytes and burr cells
    • Serum bilirubin ⩾52 µmol/L
    • Low serum haptoglobin (<25 mg/dL) or LDH ⩾2 times the upper limit
    • Severe anemia without hemorrhage


    • Preeclampsia with generalized tonic-clonic seizures, without other cause (epilepsy or drug use), or coma.

    Clinical Findings

    • Hypertension
    • Persistent or severe headache
    • CNS:
      • Altered mental status
      • Visual changes (blurred, scotoma, diplopia, loss of vision, visual field defects)
      • Hyperreflexia
      • Clonus
    • GU: RUQ/epigastric pain/tenderness
    • Pulmonary: pulmonary edema, O2 desaturation
    • Peripheral edema
    • Decreased Fetal movement

    Recommended Investigations:

    • Urinalysis: protein determination
    • Complete blood count + Peripheral blood smear
    • Haptoglobin level
    • Electrolytes
    • BUN, creatinine
    • LDH, AST, ALT, bilirubin,
    • INR, PTT, (fibrinogen if severe features present)
    • Neuroimaging – if focal neurologic signs/symptoms

    Assess fetal well-being: maternal perception of fetal movement, establish fetal heart rate (doppler or bedside ultrasound).

    Quality Of Evidence?


    Most resources are consensus guidelines set out by various organizations.


    Related Information

    Reference List

    Relevant Resources


    View all Resources


    COMMENTS (0)

    Add public comment…