Approach to the Critical Patient

Immediate stabilization

Resuscitation priorities

Seizure prophylaxis initiation

Hypertensive emergency management

Delivery decision

Delivery timing

Critical escalation triggers

Immediate escalation criteria

History

Presenting symptoms

Core symptom complex

Gestational and obstetric context

Gestational age

Risk factors

Maternal risk factors

Alarm features in history

High-risk historical features

Collateral and family history

Background history

Physical Exam

Vital signs

Hemodynamic assessment

Abdominal exam

Abdominal findings

Neurological exam

Neurologic findings

Skin and general findings

Dermatologic and edema exam

Obstetric exam

Fetal assessment

Differential Diagnosis

Life-threatening mimics

Thrombotic thrombocytopenic purpura (TTP)

Atypical hemolytic uremic syndrome (aHUS)

Acute fatty liver of pregnancy (AFLP)

Other diagnoses to consider

Severe preeclampsia without HELLP

Antiphospholipid syndrome

Acute viral hepatitis

Severe sepsis with DIC

SLE flare in pregnancy

Laboratory Tests

Diagnostic triad

HELLP diagnostic criteria (ACOG — all three required)

Severity and complication markers

Markers of severity and complications

Differentiation labs

Tests to differentiate from HELLP mimics

Routine obstetric labs

Standard workup

Diagnostic Tests

Scoring Systems

Tennessee Classification System (Martin criteria)

Mississippi Triple-Class System

LDH:AST ratio for differential diagnosis

MRI

MRI abdomen and liver

MRI brain

CT

CT abdomen and pelvis

CT head

Ultrasound

Hepatic ultrasound

Obstetric ultrasound

Point-of-care ultrasound (POCUS)

Disposition

Admission criteria

Inpatient admission required for all patients with confirmed HELLP

ICU admission criteria

ICU-level care indications

Transfer criteria

Transfer to higher level of care

Postpartum monitoring

Postpartum surveillance

Treatment

Seizure prophylaxis

Magnesium sulfate protocol

Antihypertensive therapy

First-line agents for BP ≥160/110 mmHg

Target blood pressure

Platelet management

Platelet transfusion thresholds

DIC management

Disseminated intravascular coagulation

Hepatic complication management

Hepatic subcapsular hematoma

Progressive liver failure

Corticosteroids for fetal maturity

Antenatal corticosteroid therapy if <34 weeks

Special Populations

Pregnancy

Antepartum HELLP

Recurrence risk

Geriatric

Older reproductive-age patients (35+)

Pediatrics

Neonatal and fetal considerations

Background

Epidemiology

Incidence and prevalence

Complications epidemiology

Pathophysiology

Primary mechanism

Disease progression cascade

Therapeutic Considerations

Delivery as definitive therapy

Magnesium sulfate evidence base

Corticosteroid controversy

Antihypertensive evidence

Patient Discharge Instructions

copy discharge instructions

Discharge instructions for HELLP Syndrome recovery

Return to emergency department immediately for

References

Guidelines and key sources

ACOG Practice Bulletin 222 — Gestational Hypertension and Preeclampsia (2020)

AASLD Reproductive Health and Liver Disease Practice Guidance (2021)

AGA Clinical Practice Update on Pregnancy-Related GI and Liver Disease (2024)

ACG Clinical Guideline — Liver Disease and Pregnancy (2016)

Landmark trials and differential diagnosis sources

Lancet — Pregnancy and the Liver (2025)

NEJM — Preeclampsia review (2022)

JAMA — Immune TTP (2025)

Differentiation of HELLP from TTP and aHUS (2015)

AFLP vs HELLP comparison (2022)

American Family Physician — Hypertensive Disorders of Pregnancy (2024)