HELLP syndrome and pre‑eclampsia in pregnancy
This section summarises recognition, investigation and acute emergency management of pre‑eclampsia and HELLP syndrome in the emergency department (ED).
Emphasise rapid diagnosis, urgent treatment of severe hypertension and eclampsia, appropriate monitoring (including avoidance of fluid overload), and early multidisciplinary escalation (obstetrics, anaesthetics, neonatal, critical care).
UK guidance (NICE NG133; PLGF testing HTG630/DG49) and Resuscitation Council UK recommendations should inform local protocols.
Overview
- Pre‑eclampsia is a pregnancy‑specific, multi‑system disorder usually arising after 20 weeks’ gestation but may present up to several weeks postpartum. It is a major cause of maternal and perinatal morbidity and mortality.
- HELLP syndrome (haemolysis, elevated liver enzymes, low platelets) is a severe complication of pre‑eclampsia with high risk of DIC, hepatic rupture, pulmonary oedema and need for urgent delivery.
- Definitive treatment for pre‑eclampsia/HELLP is delivery. ED priorities are maternal stabilisation, temporising treatment of blood pressure and seizures, assessment of organ dysfunction and foetal wellbeing, and expedited multidisciplinary planning (NICE NG133).
Definitions and diagnostic criteria (practical ED thresholds)
- Diagnosis of pre‑eclampsia: new hypertension at ≥20+0 weeks' gestation (systolic ≥140 mmHg and/or diastolic ≥90 mmHg) plus at least one of:
- Significant proteinuria (urine PCR ≥30 mg/mmol or ACR ≥8 mg/mmol), OR
- New maternal organ dysfunction (renal, hepatic, neurological, haematological), OR