HELLP is an acronym for a syndrome of hemolysis, elevated liver function, and/or low platelets. HELLP syndrome is thought to be a subcategory of severe preeclampsia. Patients may or may not have other signs of preeclampsia. HELLP syndrome often has a rapidly accelerating downhill course. Most clinicians deliver infants expeditiously regardless of the gestational age.

Reference: Weinstein L: Preeclampsia/eclampsia with hemolysis, elevated liver enzymes, and thrombocytopenia. Obstet Gynecol 66:657, 1985. Medline Similar articles

In the past there have been advocates for other agents, particularly phenytoin. However, a randomized controlled trial in women with eclampsia clearly favored MgSO4 over phenytoin for recurrent seizure prophylaxis.

Reference: Witlin AG, Sibai BM: Magnesium sulfate therapy in preeclampsia and eclampsia. Obstet Gynecol 92:883-889, 1998. Medline Similar articles Full article

Mild elevations in blood pressure usually are not treated with antihypertensives. With more marked elevations (diastolic > 110 mmHg or a mean arterial pressure > 125 mmHg), medications with rapid onset, such as hydralazine and labetalol, are used intravenously. Generally such management is undertaken while also proceeding with delivery, due to the severity of the disease.
Diuretics are generally not used as a first-line treatment because preeclampsia is characterized by vasoconstriction and intravascular depletion, which are worsened by diuretics. As for other antihypertensive agents, work has shown that treatment of patients with mild-to-moderate hypertension (i.e., 90-110 mmHg diastolic pressure) does not decrease perinatal morbidity or mortality. Therefore, antihypertensive therapy is not usually used. Severe hypertension (> 110 mmHg diastolic pressure) is associated with severe preeclampsia. More than likely, delivery needs to be undertaken in this circumstance, and rapid-acting antihypertensive agents (i.e., intravenous hydralazine or labetalol) are used to control severe hypertension during labor.
In a patient with known chronic hypertension whose elevated blood pressure is believed to be due to underlying disease rather than preeclampsia, an increase in antihypertensive therapy may be appropriate

Reference:

1. American College of Obstetricians and Gynecologists: Diagnosis and Management of Preeclampsia and Eclampsia. ACOG Practice Bulletin No. 33. Obstet Gynecol 99:159-167, 2002.
2. National High Blood Pressure Education Program: Working Group Report on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 183:S1-S22, 2000.

In the past there have been advocates for other agents, particularly phenytoin. However, a randomized controlled trial in women with eclampsia clearly favored MgSO4 over phenytoin for recurrent seizure prophylaxis.

Reference:

1. Witlin AG, Sibai BM: Magnesium sulfate therapy in preeclampsia and eclampsia. Obstet Gynecol 92:883-889, 1998. Medline Similar articles Full article
2. Lucas MJ, Leveno KJ, Cunningham FG: A comparison of magniesuium sulfate with phenytoin for the prevention of eclampsia. N Engl J Med 333:201, 1995. Medline Similar articles Full article

Preeclampsia is classified as mild and severe. Preeclampsia is considered severe if any one of a number of systems shows evidence of significant compromise. Any of the following parameters classify a woman’s preeclampsia as severe:

• Systolic blood pressure > 160 mmHg or diastolic blood pressure > 110 mmHg on two occasions at least 6 hours apart
• Proteinuria ≥ 5 gm/24 hr
• Oliguria < 500 cc/24 hr
• Cerebral or visual symptoms
• Epigastric or right upper quadrant pain
• Pulmonary edema or cyanosis
• Low platelets
• Elevated liver function tests
• Fetal growth restriction

The definition of mild preeclampsia is any preeclampsia that is not considered severe. There is no category of moderate preeclampsia.

The classification of severity is directly related to management and the decision about when to deliver the baby.

Reference:

1. American College of Obstetricians and Gynecologists: Diagnosis and Management of Preeclampsia and Eclampsia. ACOG Practice Bulletin No. 33. Obstet Gynecol 99:159-167, 2002.
2. American College of Obstetricians and Gynecologists: Chronic Hypertension in Pregnancy. ACOG Practice Bulletin No. 29. Obstet Gynecol 98:177-185, 2001.

Numerous interventions have been attempted. Dietary manipulation, with decreased sodium intake or increased calcium intake, and pharmacologic therapy, with prophylactic low-dose aspirin, have been extensively studied with randomized controlled trials. Unfortunately, neither of these interventions has been able to reduce the incidence of preeclampsia.

Reference: American College of Obstetricians and Gynecologists: Diagnosis and Management of Preeclampsia and Eclampsia. ACOG Practice Bulletin No. 33. Obstet Gynecol 99:159-167, 2002.

Yes. If preeclampsia occurs in the first pregnancy, there is a 25% chance of recurrence in subsequent pregnancies. The recurrence rate appears to be affected by gestational age at onset in the first pregnancy, severity, underlying maternal diseases, and underlying obstetric diseases. Women who develop preeclampsia early in pregnancy, or who develop severe preeclampsia; those with chronic medical conditions (e.g., chronic hypertension, renal disease); and those with no apparent fetal contribution (such as fetal aneuploidy) are at greater risk to develop preeclampsia in the future.
Multiparous patients who have had preeclampsia have a recurrence rate of up to 50% with subsequent pregnancies.

Reference: American College of Obstetricians and Gynecologists: Diagnosis and Management of Preeclampsia and Eclampsia. ACOG Practice Bulletin No. 33. Obstet Gynecol 99:159-167, 2002.