Mastering Pre-eclampsia, Eclampsia & HELLP for the MSRA: A Rapid-Review Guide

Ann Augustin
Jun 30
2 min read

When it comes to high-yield obstetric emergencies on the MSRA, few topics rival the importance—and frequency—of pre-eclampsia, eclampsia, and HELLP syndrome. These conditions are not only clinically significant but also exam favourites, especially in the clinical problem-solving component.

Here’s your streamlined, exam-focused guide to mastering them.

🔍 Core Definitions to Memorise

Gestational Hypertension: New-onset BP ≥140/90 mmHg after 20 weeks without proteinuria.
Pre-eclampsia: New HTN ≥140/90 mmHg plus proteinuria (≥2+ dipstick or protein:creatinine ratio >30 mg/mmol) after 20 weeks.
Eclampsia: Pre-eclampsia + generalised seizures.
HELLP Syndrome: Haemolysis, Elevated Liver enzymes, Low Platelets—often co-existing with or following pre-eclampsia.

🚨 Recognising the Red Flags

MSRA questions love to use subtle and classic signs:

Severe headache, visual disturbance, RUQ or epigastric pain, vomiting
Sudden onset hand/facial swelling (buzzword)
Laboratory signs: rising AST/ALT, thrombocytopenia, haemolysis (↑LDH, schistocytes), and fetal growth restriction

If you see these, think impending eclampsia or HELLP.

📌 Management Principles for MSRA

Significant BP (≥160/110) at any point = urgent hospital admission
Proteinuria ≥2+ without HTN? → Admit; could be early pre-eclampsia
Pre-eclampsia at ≥37 weeks → Offer delivery (even if asymptomatic)
<34 weeks and stable? → Steroids (e.g., betamethasone) for fetal lungs, monitor closely

For seizure prevention/treatment in eclampsia:

IV magnesium sulfate (MgSO₄): 4 g over 5–10 minutes → 1 g/hr infusion
Monitor for toxicity: check reflexes, respiratory rate, and urine output

🧠 Atypical but Crucial Points

Pre-eclampsia before 20 weeks? Think molar pregnancy or triploidy
Superimposed pre-eclampsia: Chronic HTN + new proteinuria or symptoms = red flag
Aspirin prophylaxis (75 mg daily from 12 weeks) is key in:
- ≥1 high-risk factor (e.g., prior pre-eclampsia, CKD, SLE, diabetes)
- ≥2 moderate-risk factors (e.g., BMI ≥35, age ≥40, multiple pregnancy)

📉 Why Aspirin Works

Aspirin inhibits thromboxane A2, reducing platelet aggregation and vasoconstriction while preserving prostacyclin. This helps improve placental perfusion, trophoblast function, and endothelial stability—all central in pre-eclampsia pathogenesis.

🎯 Exam-Ready Numbers to Lock In

Significant HTN: ≥160/110 mmHg
Significant proteinuria: PCR >30 mg/mmol or ≥2+ dipstick
MgSO₄ dose: 4 g IV bolus → 1 g/hr infusion
HELLP platelets: <100 × 10⁹/L
Aspirin dose: 75 mg OD from 12 weeks to delivery

🔒 Final Takeaway

Pre-eclampsia is a classic MSRA “storyline”: a pregnant woman in her third trimester with vague but progressive symptoms. Recognise the red flags early, act decisively based on BP and proteinuria thresholds, and always prioritise maternal and fetal safety.

By anchoring your answers to these clinchers and thresholds, you’ll be well-prepared to tackle any vignette on the topic with confidence.

📚 References: