Clinical features

Clinical features of pre-eclampsia:

• Asymptomatic hypertension (picked up on screening or incidentally when presenting with another issue)
• Headache (usually frontal)
• RUQ or epigastric pain (also a symptom of HELLP syndrome)
• Nausea and vomiting
• Oedema (common but not specific). Especially if rapidly increasing and involving face and hands.
• Visual disturbance (flashing lights in the visual fields or scotomata)
• Shortness of breath (uncommon but can occur due to pulmonary oedema)
• Hyper-reflexia and/or clonus

Clinical features of eclampsia:

• Tonic-clonic seizures
  • often in the setting of known pre-eclampsia
  • can be at first presentation particularly if not engaged in antenatal care (only one third of women in the UK experiencing their first eclamptic seizure have established hypertension and proteinuria in the preceding week)

Learning bite

Many of the symptoms of pre-eclampsia are non-specific.  Pregnant patients presenting with headache or gastritis-like symptoms should have pre-eclampsia considered in the differential.

Crises in pre-eclampsia:

• Acute kidney injury
• HELLP syndrome
• Placental abruption
• Pulmonary oedema (may be sudden onset and catastrophic)
• Transient left ventricular systolic or diastolic dysfunction
• Eclampsia
• Hepatic rupture
• DIC
• Haemorrhagic stroke
• Cortical blindness

Clinical features of HELLP syndrome:

HELLP syndrome is a variant of severe pre-eclampsia characterised by haemolysis, elevated liver enzymes and low platelets.⁴   

Symptoms and signs are similar to those of pre-eclampsia but also include jaundice and bleeding.

1. Haemolysis (H):
   • anaemia
   • dark urine
   • raised LDH (>600), raised bilirubin, schistocytes on blood film
2. Elevated liver enzymes (EL):
   • Epigastric/RUQ pain/tenderness
   • raised transaminases
   • abnormal clotting (prolonged PT)
3. Low platelets (LP):
   • Platelets < 100

Learning bite

HELLP syndrome is characterised by haemolysis, elevated liver enzymes and low platelets.