Preeclampsia vs Eclampsia and HELLP
How to tell Preeclampsia and Eclampsia and HELLP apart when a board question makes them look alike.
Preeclampsia is hypertension with proteinuria/end-organ signs; eclampsia adds seizures; HELLP adds hemolysis, liver enzymes, and low platelets.
Side by side
Preeclampsia is new hypertension after 20 weeks with proteinuria or end-organ signs such as thrombocytopenia, renal injury, liver injury, pulmonary edema, or neurologic symptoms.
Eclampsia is preeclampsia with seizures; HELLP is hemolysis, elevated liver enzymes, and low platelets, often with right upper quadrant pain.
Abnormal placentation causes endothelial dysfunction, vasoconstriction, capillary leak, and maternal organ injury.
Severe endothelial activation can provoke cerebral irritability with seizures, microangiopathic hemolysis, systemic platelet consumption, and periportal hepatic injury causing AST/ALT elevation and RUQ pain.
Hypertension after 20 weeks, proteinuria, elevated creatinine, thrombocytopenia, transaminitis, headache, or visual symptoms support preeclampsia.
Generalized seizure supports eclampsia; schistocytes, high AST/ALT, low platelets, and RUQ pain support HELLP.
The trap
Proteinuria is not required if severe features exist, and seizures or HELLP labs move the diagnosis beyond uncomplicated preeclampsia.
Watch it explained
Test it nowThe repair move
For hypertensive pregnancy disease, first confirm after 20 weeks, then look for seizure or HELLP labs.
Try a free question
CoreA 31-year-old woman at 33 weeks gestation has 2 days of headache and vision changes. BP is 168/110 mm Hg on two readings 6 hours apart. Urine protein/creatinine ratio is 0.6, creatinine is 1.3 mg/dL (baseline 0.7), and platelets are 142,000/uL. There is no seizure. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Preeclampsia with severe features. New onset hypertension after 20 weeks with proteinuria and end-organ involvement (renal injury, headache, vision changes) defines preeclampsia, and the severe features include systolic >=160 or diastolic >=110, severe headache, or renal/hepatic dysfunction.
Why the other choices are tempting
- B. Eclampsia requires a generalized seizure in the setting of preeclampsia, which this patient has not had.
- C. HELLP requires hemolysis, elevated liver enzymes, and low platelets (typically <100,000/uL); this patient has only mild thrombocytopenia.
- D. Chronic hypertension begins before 20 weeks or precedes pregnancy; this patient's hypertension is new at 33 weeks.
- E. Gestational hypertension has no proteinuria or end-organ injury; this patient has both.
Flashcards
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What timing supports preeclampsia?
New hypertension after 20 weeks gestation supports preeclampsia.
What turns preeclampsia into eclampsia?
Seizures in a patient with preeclampsia define eclampsia.
Quick answers
What is the fastest way to tell Preeclampsia from Eclampsia and HELLP?
Preeclampsia is hypertension with proteinuria/end-organ signs; eclampsia adds seizures; HELLP adds hemolysis, liver enzymes, and low platelets.
What is the key clue for Preeclampsia?
Preeclampsia is new hypertension after 20 weeks with proteinuria or end-organ signs such as thrombocytopenia, renal injury, liver injury, pulmonary edema, or neurologic symptoms.
What is the key clue for Eclampsia and HELLP?
Eclampsia is preeclampsia with seizures; HELLP is hemolysis, elevated liver enzymes, and low platelets, often with right upper quadrant pain.
What is the common trap with Preeclampsia vs Eclampsia and HELLP?
Proteinuria is not required if severe features exist, and seizures or HELLP labs move the diagnosis beyond uncomplicated preeclampsia.