Differential Diagnosis
Differential Diagnosis
The differential diagnosis will differ depending on the presenting symptoms/signs.2
| Presentation | Differential diagnosis | Differentiating features |
| Hypertension | Chronic hypertension | Pre-existing hypertension, absence of new onset proteinuria |
| Gestational hypertension | New onset hypertension, no proteinuria or other features of pre-eclampsia | |
| Headaches/ visual disturbance | Anti-phospholipid syndrome | Possible history of recurrent miscarriage/VTE/stroke/TIAs |
| Thrombotic thrombocytopaenia purpura | May have some/all of fever/confusion/low platelets/renal failure/haemolytic anaemia | |
| Cerebral venous sinus thrombosis | Absence of hypertension, progressive severe headache, neurological deficits | |
| Seizures | Epilepsy | Previous diagnosis of epilepsy or previous seizure, absence of hypertension/proteinuria |
| Thrombotic thrombocytopaenia purpura | May have some/all of fever/confusion/low platelets/renal failure/haemolytic anaemia | |
| Cerebral haemorrhage | Patients with uncontrolled hypertension are at risk of cerebral haemorrhage. | |
| Abdominal pain/vomiting | HELLP syndrome | May not have high BP or proteinuria. Haemolysis/thrombocytopaenia/ elevated liver transaminases |
| Acute fatty liver of pregnancy | Part of pre-eclampsia spectrum. Differentiate from HELLP syndrome by hypoglycaemia which is a feature of AFLP but not HELLP. | |
| Gallbladder disease | Colicky, RUQ pain, normal BP/urinalysis. LFTs may show raised bilirubin/ALP, USS showing gallstones. | |
| Pancreatitis | Previous history of pancreatitis/alcohol excess, normal BP, raised amylase/USS suggesting pancreatitis. | |
| Haemolytic uraemic syndrome | Bloody diarrhoea, microangiopathic haemolytic anaemia, low platelets/AKI |
Learning bite
There is a wide differential diagnosis for pre-eclampsia that needs to be considered to prevent other serious diagnoses being missed.