## Clinical Diagnosis This patient has **severe preeclampsia with HELLP syndrome features** (Hemolysis-Elevated Liver enzymes-Low Platelets): - BP ≥160/110 mmHg (severe range) - Proteinuria ≥2+ - Right upper quadrant pain (hepatic capsule stretch) - Thrombocytopenia (platelets <100,000/μL) **Key Point:** HELLP syndrome is a medical emergency requiring urgent delivery regardless of gestational age, as maternal mortality and morbidity increase exponentially with expectant management. ## Management Algorithm ```mermaid flowchart TD A[Severe Preeclampsia + HELLP]:::urgent --> B{Maternal/Fetal Stability?}:::decision B -->|Unstable or HELLP present| C[Start IV MgSO4 immediately]:::action C --> D[Prepare for urgent delivery]:::action D --> E[Deliver within 12-24 hours]:::outcome B -->|Stable, no HELLP| F[Antihypertensive + Corticosteroids]:::action F --> G[Plan delivery at 34-37 weeks]:::outcome ``` **High-Yield:** HELLP syndrome is an absolute indication for delivery. Magnesium sulphate is given for seizure prophylaxis (not blood pressure control) and should be initiated immediately in severe preeclampsia/HELLP. ## Rationale for Next Steps | Step | Indication | Timing | |------|-----------|--------| | **IV MgSO₄** | Seizure prophylaxis in severe PE/HELLP | Immediately | | **Corticosteroids** | Fetal lung maturity (34 weeks) | Before delivery | | **Delivery** | HELLP syndrome present | Within 12–24 hours | | **Monitoring** | Maternal organ function | Continuous during labor | **Clinical Pearl:** The presence of thrombocytopenia (<100,000/μL) in a hypertensive pregnant woman is pathognomonic for HELLP and mandates urgent delivery. Platelet counts may continue to fall in the first 24–48 hours postpartum. **Warning:** Do NOT delay delivery for investigations (24-hour urine protein) or expectant management in HELLP syndrome. Maternal mortality increases significantly with each day of delay. [cite:Williams Obstetrics 26e Ch 40]
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