Preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelets
syndrome are major obstetric disorders that are associated with substantial maternal
and perinatal morbidities. As a result, it is important that clinicians make timely
and accurate diagnoses to prevent adverse maternal and perinatal outcomes associated
with these syndromes. In general, most women will have a classic presentation of preeclampsia
(hypertension and proteinuria) at > 20 weeks of gestation and/or < 48 hours after
delivery. However, recent studies have suggested that some women will experience preeclampsia
without ≥ 1 of these classic findings and/or outside of these time periods. Atypical
cases are those that develop at < 20 weeks of gestation and > 48 hours after delivery
and that have some of the signs and symptoms of preeclampsia without the usual hypertension
or proteinuria. The purpose of this review was to increase awareness of the nonclassic
and atypical features of preeclampsia-eclampsia. In addition, a stepwise approach
toward diagnosis and treatment of patients with these atypical features is described.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Report on high blood pressure in pregnancy.Am J Obstet Gynecol. 2000; 183: S1-S22
- Diagnosis and management of gestational hypertension and preeclampsia.Obstet Gynecol. 2003; 102: 181-192
- Diagnosis and management of preeclampsia and eclampsia.Obstet Gynecol. 2001; 98: 159-167
- Pregnancy outcomes in healthy nulliparous women who subsequently developed hypertension: calcium for preeclampsia prevention study group.Obstet Gynecol. 2000; 95: 24-28
- The detection, investigation, and management of hypertension in pregnancy: full consensus statement of recommendations from the Council of Australian Society of the study of hypertension in pregnancy.Aust N Z J Obstet Gynaecol. 2000; 40: 139
- The classification and diagnosis of the hypertensive disorders of pregnancy: statement of the International Society for the study of hypertension in pregnancy (ISSHP).Hypertens Pregnancy. 2001; 20: IX-XIV
- Eclampsia VIII: risk factors for maternal morbidity.Am J Obstet Gynecol. 2000; 182: 307-312
- Diagnosis, controversies and management of the HELLP syndrome.Obstet Gynecol. 2004; 103: 981-991
- Diagnosis, differential diagnosis and management of eclampsia.Obstet Gynecol. 2005; 105: 402-410
- Hypertension in pregnancy: maternal and fetal outcomes according to laboratory and clinical features.Med J Aust. 1996; 165: 360-365
- Eclampsia in the United Kingdom 2005.BJOG. 2007; 114: 1072-1078
- Clinical significance of proteinuria in pregnancy.Obstet Gynecol Surv. 2007; 62: 117-124
- Mild gestational hypertension remote from term: progression and outcome.Am J Obstet Gynecol. 2001; 184: 979-983
- Does gestational hypertension become preeclampsia?.BJOG. 1998; 105: 1177-1184
- Serious perinatal complications of non-proteinuric hypertension: an international, multicentre, retrospective cohort study.J Obstet Gynaecol Can. 2003; 2: 372-382
- Adverse perinatal outcomes are significantly higher in severe gestational hypertension than in mild preeclampsia.Am J Obstet Gynecol. 2002; 186: 66-71
- Expectant management of severe preeclampsia remote from term: patient selection, treatment, and delivery indications.Am J Obstet Gynecol. 2007; 196: 514.e1-514.e9
- Understanding and managing HELLP syndrome: the integral role of aggressive glucocorticoids for mother and child.Am J Obstet Gynecol. 2006; 195: 914-934
- Should the definition of preeclampsia include a rise in diastolic blood pressure of ≥15 mm Hg to a level of <90 mm Hg in association with proteinuria?.Am J Obstet Gynecol. 2000; 183: 787-792
- World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women.Am J Obstet Gynecol. 2006; 194: 639-649
- Circulating angiogenic factors in preeclampsia superimposed on chronic glomerulonephritis.Am J Obstet Gynecol. 2006; 194: 551-556
- Circulating angiogenic factors in gestational proteinuria without hypertension.Am J Obstet Gynecol. 2007; 197: S134
- Trophoblastic microemboli as a marker for preeclampsia-eclampsia in sudden unexpected maternal death: a case report and review of the literature.Am J Forensic Med Pathol. 2000; 21: 354-358
- Renal disease in women with severe preeclampsia or gestational proteinuria.Obstet Gynecol. 2000; 96: 945-949
- Partial mole, triploidy and proteinuric hypertension: two case reports.Aust N Z J Obstet Gynaecol. 2000; 40: 215-218
- A case of partial mole and atypical type I triploidy associated with severe HELLP syndrome at 18 weeks' gestation.Ultrasound Obstet Gynecol. 2002; 20: 403-404
- Acute onset of severe hemolysis, elevated liver enzymes, and low platelet count syndrome in a patient with partial hydatidiform mole at 17 weeks gestation.Am J Perinatol. 2006; 23: 163-166
- Severe syndrome of hemolysis, elevated liver enzymes and low platelets (HELLP) in the 18th week of pregnancy associated with the antiphospholipid-antibody syndrome.Acta Obstet Gynecol Scand. 2003; 82: 679-680
- HELLP syndrome: a rare, early presentation at 17 weeks of gestation.Obstet Gynecol. 2007; 110: 525-527
- “Pure” preeclampsia before 20 weeks of gestation: a unique entity.BJOG. 2003; 110: 1034-1035
- Imitators of severe preeclampsia.Obstet Gynecol. 2007; 109: 956-966
- Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment.J Perinatol. 2007; 27: 335-342
- Increased uterine artery vascular impedance related to adverse outcome of pregnancy but is present in only one-third of late third-trimester preeclamptic women.Ultrasound Obstet Gynecol. 2005; 25: 459-463
- Late postpartum eclampsia revisited.Obstet Gynecol. 1994; 83: 502-505
- Delayed postpartum preeclampsia: an experience of 151 cases.Am J Obstet Gynecol. 2004; 190: 1464-1466
- The management of postpartum hypertension.BJOG. 2002; 109: 733-738
- Eclampsia in the United Kingdom.BMJ. 1994; 308: 1395-1400
- Epidemiology of eclampsia in Colombia.Int J Gynaecol Obstet. 1998; 61: 1-8
- Preeclampsia into eclampsia: toward a new paradigm.Am J Obstet Gynecol. 2000; 182: 1389-1396
- Late postpartum eclampsia: a preventable disease?.Am J Obstet Gynecol. 2002; 186: 1174-1177
- Our experience with eclampsia in Singapore.Singapore Med J. 2003; 44: 88-93
- Postpartum headache: is your work-up complete?.Am J Obstet Gynecol. 2007; 196: 318.e1-318.e7
- Call-Fleming postpartum angiopathy in the puerperium: a reversible cerebral vasoconstriction syndrome.Obstet Gynecol. 2006; 107: 446-449
- Dexamethasone treatment dose not improve the outcome of women with HELLP syndrome: a double-blind, placebo-controlled, randomized clinical trial.Am J Obstet Gynecol. 2005; 193: 1591-1598
- Postpartum dexamethasone for women with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome: a double-blind, placebo-controlled, randomized clinical trial.Am J Obstet Gynecol. 2008; 198: 283.e1-283.e8
- Dexamethasone to improve maternal outcome in women with hemolysis, elevated liver enzymes, and low platelets syndrome.Am J Obstet Gynecol. 2005; 193: 1587-1590
- Mild to moderate reduction of a von Willebrand factor cleaving protease (ADAMTS-13) in pregnant women with HELLP microangiopathic syndrome.Haematologica. 2003; 88: 1029-1034
- Soluble endoglin and other circulating angiogenic factors in preeclampsia.N Engl J Med. 2006; 355: 992-1005
- Circulating angiogenic factors and the risk for preeclampsia.N Engl J Med. 2004; 350: 672-683
- Diagnostic utility of soluble fms-like tyrosine kinase 1 and soluble endoglin in hypertensive diseases of pregnancy.Am J Obstet Gynecol. 2007; 197: 28.e1-28.e6
- Soluble endoglin as a second-trimester marker for preeclampsia.Am J Obstet Gynecol. 2007; 197: 174.e1-174.e6
Article Info
Publication History
Published online: November 19, 2008
Accepted:
July 28,
2008
Received in revised form:
July 2,
2008
Received:
June 4,
2008
Footnotes
Cite this article as: Sibai BM, Stella CL. Diagnosis and management of atypical preeclampsia-eclampsia. Am J Obstet Gynecol 2009;200:481.e1-481.e7.
Identification
Copyright
© 2009 Mosby, Inc. Published by Elsevier Inc. All rights reserved.