Eclampsia and HELLP syndrome

Four minutes, in order. The midwife calls you to a bed at 32 weeks. The woman is rigid, then jerking, and the bed rail is banging. Her partner is shouting. There is a cardiotocograph running and it has gone flat. The order below: left lateral, oxygen, magnesium, pressure, labs, fetal assessment, birth planning.^[3][9]

Overview and definition

Eclampsia is a generalised tonic-clonic seizure in a woman with preeclampsia, with no other cause found. It sits inside the ISSHP 2021 neurological criterion, and it is a manifestation of the disease rather than a separate condition.^[1][3]

HELLP syndrome is haemolysis, elevated liver enzymes and a low platelet count — a severe end of the preeclampsia spectrum that can arrive without much hypertension and without any proteinuria.^[10][3]

• Timing of eclampsia: antepartum, intrapartum, postpartum, and late postpartum (more than 48 hours after birth). Postpartum seizures are a substantial share.^[9][19]
• HELLP timing: roughly two-thirds antepartum, one-third postpartum, with the postpartum group typically presenting within 48 hours of birth.^[10][3]

^[9]

References20ShowHide

1. [1]Magee LA, Brown MA, Hall DR, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice Pregnancy Hypertens, 2022.PMID 35066406
2. [2]Shanmugalingam R, Barrett HL, Beech A, et al. A summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) hypertension in pregnancy guideline Med J Aust, 2024.PMID 38763516
3. [3]American College of Obstetricians and Gynecologists Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222 Obstet Gynecol, 2020.PMID 32443079
4. [4]Eclampsia Trial Collaborative Group Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial Lancet, 1995.PMID 7769899
5. [5]Altman D, Carroli G, Duley L, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial Lancet, 2002.PMID 12057549
6. [6]Duley L, Gülmezoglu AM, Henderson-Smart DJ, Chou D Magnesium sulphate and other anticonvulsants for women with pre-eclampsia Cochrane Database Syst Rev, 2010.PMID 21069663
7. [7]Diaz V, Long Q, Oladapo OT Alternative magnesium sulphate regimens for women with pre-eclampsia and eclampsia Cochrane Database Syst Rev, 2023.PMID 37815037
8. [8]Duley L, Matar HE, Almerie MQ, Hall DR Alternative magnesium sulphate regimens for women with pre-eclampsia and eclampsia Cochrane Database Syst Rev, 2010.PMID 20687086
9. [9]Knight M Eclampsia in the United Kingdom 2005 BJOG, 2007.PMID 17617191
10. [10]Martin JN Jr, Rinehart BK, May WL, Magann EF, Terrone DA, Blake PG The spectrum of severe preeclampsia: comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification Am J Obstet Gynecol, 1999.PMID 10368474
11. [11]Martin JN Jr, Brewer JM, Wallace K, et al. Hellp syndrome and composite major maternal morbidity: importance of Mississippi classification system J Matern Fetal Neonatal Med, 2013.PMID 23387811
12. [12]Woudstra DM, Chandra S, Hofmeyr GJ, Dowswell T Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy Cochrane Database Syst Rev, 2010.PMID 20824872
13. [13]Chahine KM, Shepherd MC, Sibai BM Association of Subcapsular Liver Hematoma With Preeclampsia, Eclampsia, or Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome Obstet Gynecol, 2025.PMID 39787605
14. [14]Ch'ng CL, Morgan M, Hainsworth I, Kingham JG Prospective study of liver dysfunction in pregnancy in Southwest Wales Gut, 2002.PMID 12427793
15. [15]Fakhouri F, Scully M, Provôt F, et al. Management of thrombotic microangiopathy in pregnancy and postpartum: report from an international working group Blood, 2020.PMID 32808006
16. [16]Rana S, Lemoine E, Granger JP, Karumanchi SA Preeclampsia: Pathophysiology, Challenges, and Perspectives Circ Res, 2019.PMID 30920918
17. [17]Magee LA, Nicolaides KH, von Dadelszen P Preeclampsia N Engl J Med, 2022.PMID 35544388
18. [18]Roberts D, Brown J, Medley N, Dalziel SR Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth Cochrane Database Syst Rev, 2017.PMID 28321847
19. [19]Sibai BM Etiology and management of postpartum hypertension-preeclampsia Am J Obstet Gynecol, 2012.PMID 21963308
20. [20]Bellamy L, Casas JP, Hingorani AD, Williams DJ Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis BMJ, 2007.PMID 17975258