Investigations

It would not be appropriate for all the recommended investigations for pre-eclampsia to be carried out within the emergency department, however there are some simple bedside tests and blood tests that can help to diagnose pre-eclampsia and assess for complications.     Referral should be made to obstetrics for specialist management. 

• Blood pressure monitoring repeated to confirm (with correct BP cuff size)
• Blood tests
• Full blood count (looking specifically at platelets)
• Renal function (risk of AKI)
• Liver function tests (risk of HELLP syndrome – haemolysis, elevated liver enzymes, low platelets)

Also consider: 

• blood film (risk of haemolysis and micro-angiopathic haemolytic anaemia)
• clotting screen (if thrombocytopaenic)

• Urine
• Urinalysis looking for protein (preferably use an automated reader as this is more accurate); 1+ or more of protein is significant.
• If 1+ or more of protein is present on urinalysis, send urine for protein:creatinine ratio (30mg/mmol confirms proteinuria) or albumin creatinine ratio (>8mg/mmol significant)

After referral to obstetrics, further tests will be arranged to assess fetal wellbeing:

• Cardiotocography (CTG)
• Ultrasound (for fetal growth, umbilical artery doppler and amniotic fluid index)

Learning bite

Initial investigations in the ED for possible pre-eclampsia include blood pressure measurement, urinalysis and blood tests (FBC, U+E, and LFTs).