Pre-eclampsia, Eclampsia & HELLP Syndrome

Also known as Pre-eclampsia · Eclampsia · HELLP syndrome · Magnesium sulfate · Calcium gluconate antidote · Postpartum pre-eclampsia

The hypertensive spectrum of pregnancy spans pre-eclampsia (new hypertension over 140 over 90 plus proteinuria or end-organ dysfunction after 20 weeks), eclampsia (plus seizures), and HELLP (haemolysis, elevated liver enzymes, low platelets). The mechanism is abnormal placentation releasing anti-angiogenic sFlt-1, driving generalised endothelial dysfunction. Management is magnesium sulfate for seizure prophylaxis and treatment (calcium gluconate is the antidote), controlled blood-pressure reduction with labetalol, hydralazine, or nifedipine, and delivery as the definitive cure.

high21 referencesUpdated 3 Sept 202611 min readSource-verified · Sept 2026

Checked against its sources on 3 Sept 2026

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8 MCQs

The one-line answer

Pre-eclampsia is new hypertension (over 140 over 90) with proteinuria or end-organ dysfunction after 20 weeks, driven by abnormal placentation and anti-angiogenic sFlt-1 causing generalised endothelial dysfunction. Eclampsia adds seizures; HELLP adds haemolysis, elevated liver enzymes, and low platelets. The management triad is magnesium sulfate for seizure prophylaxis and treatment (4 g IV loading then 1 to 2 g per hour by controlled infusion pump, with intravenous calcium gluconate as the antidote — 10 mL of 10 percent in the Omu protocol), urgent treatment of severe hypertension (as soon as possible within 30 to 60 minutes of confirmed severe hypertension, with IV labetalol or hydralazine or immediate-release oral nifedipine), and planning for delivery.^[4]^[6]^[10]^[18]

Meet the patient

A 29-year-old primigravida at 38 weeks gestation is brought to the emergency department after a two-minute generalised tonic-clonic seizure at home. She is post-ictal, drowsy, and confused. Her blood pressure is 172 over 114, she has gross peripheral and facial oedema, brisk reflexes with six beats of clonus, and proteinuria of 4.2 g per day. Her platelets are 88, AST 165, and LDH 720 with schistocytes on the smear.^[2]^[7]

Three questions. Has she seized (magnesium now)? Is her blood pressure over 160 systolic or 110 diastolic (urgent antihypertensive therapy — as soon as possible within 30 to 60 minutes — to reduce the risk of maternal stroke)? Does she need delivery (the definitive treatment)? This woman has eclampsia with HELLP — all three answers are yes.^[2]^[8]^[10]

References21Show

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