Preeclampsia

HELLP syndrome is a thrombotic microangiopathy of pregnancy, a severe-feature variant of preeclampsia defined by hemolysis, transaminases at least twice the upper limit of normal, and a platelet count under 100,000/uL. Delivery is the only curative treatment; management pairs blood pressure control and magnesium sulfate seizure prophylaxis with prompt, gestational-age-guided delivery.

Gestational hypertension is new hypertension after 20 weeks of pregnancy without proteinuria or other features of preeclampsia. It requires close surveillance because a substantial proportion progresses to preeclampsia; management is blood pressure control with pregnancy-safe agents and timely delivery near term.

Chronic hypertension in pregnancy is hypertension predating pregnancy or diagnosed before 20 weeks. It raises the risk of superimposed preeclampsia, growth restriction, and abruption, so management is blood pressure control with pregnancy-safe agents, low-dose aspirin prophylaxis, close surveillance, and switching off teratogenic drugs preconception.

Acute fatty liver of pregnancy is a rare, life-threatening third-trimester disorder of microvesicular hepatic steatosis driven by a fetal-maternal fatty-acid oxidation mismatch (classically LCHAD deficiency); it is treated by immediate delivery, the only intervention that reverses the maternal disease.

Disseminated intravascular coagulation is a secondary, systemic activation of coagulation and fibrinolysis, most often from sepsis, that simultaneously consumes platelets and clotting factors, causing microvascular thrombosis and bleeding. Diagnosis rests on a laboratory constellation, thrombocytopenia, prolonged PT and aPTT, low fibrinogen, and elevated D-dimer, in a predisposing clinical setting, and management centers on treating the underlying trigger while replacing blood components only for active or high-risk bleeding.

Thrombotic thrombocytopenic purpura is a thrombotic microangiopathy caused by severe ADAMTS13 deficiency that lets ultralarge von Willebrand factor multimers drive platelet microthrombi; the key dyad of microangiopathic hemolytic anemia plus thrombocytopenia without another cause mandates the PLASMIC score, an ADAMTS13 activity and inhibitor level, and emergent plasma exchange started before results return.

Hemolytic uremic syndrome is a thrombotic microangiopathy defined by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury, most often triggered in children by Shiga toxin-producing Escherichia coli O157:H7 after bloody diarrhea. Diagnosis rests on schistocytes with a negative Coombs test plus a normal ADAMTS13 level to exclude TTP, and typical STEC-HUS is managed supportively while antibiotics and antimotility agents are avoided, whereas complement-mediated atypical HUS requires eculizumab.

Gestational diabetes mellitus is carbohydrate intolerance first identified in the second or third trimester, diagnosed with a 50-g glucose challenge test followed by a confirmatory 100-g oral glucose tolerance test. Insulin is first-line pharmacologic therapy when glycemic targets are not met with diet and exercise, and untreated hyperglycemia drives fetal macrosomia, shoulder dystocia, neonatal hypoglycemia, and later maternal type 2 diabetes.

Ischemic stroke is sudden focal neurologic deficit from arterial occlusion confirmed by infarction on neuroimaging. Diagnosis relies on urgent noncontrast head CT to exclude hemorrhage; treatment is IV alteplase within 4.5 hours and mechanical thrombectomy for large-vessel occlusion within an extended window, followed by antiplatelet therapy and risk-factor control.

Antiphospholipid syndrome is an acquired autoimmune thrombophilia in which antiphospholipid antibodies cause recurrent venous and arterial thrombosis and pregnancy morbidity, paradoxically prolonging the aPTT in vitro while promoting clotting in vivo. Diagnosis requires a qualifying clinical event plus a laboratory antibody confirmed positive on two occasions at least 12 weeks apart, and thrombotic disease is treated with indefinite warfarin rather than a DOAC.