Differentials
Chronic hypertension
SIGNS / SYMPTOMS
Pre-existing hypertension before pregnancy.
Retinopathy commonly seen in longstanding disease.
INVESTIGATIONS
Urinalysis: absence of new-onset proteinuria.
Gestational hypertension
SIGNS / SYMPTOMS
No differentiating signs or symptoms.
INVESTIGATIONS
Urinalysis: absence of proteinuria.
Epilepsy
SIGNS / SYMPTOMS
History of epilepsy or seizures before pregnancy.
BP normal.
Focal neurological deficits or symptoms.
INVESTIGATIONS
Urinalysis: absence of proteinuria.
Antiphospholipid antibody syndrome
SIGNS / SYMPTOMS
History of repeated early pregnancy loss.
History of venous thrombosis, stroke, or transient ischaemic attack.
INVESTIGATIONS
Lupus anticoagulant: positive.
Anticardiolipin antibodies: medium or high titre.
Anti-beta-2-glycoprotein I: titre >99th percentile.
Thrombotic thrombocytopenic purpura
SIGNS / SYMPTOMS
Presentation before 20 weeks' gestation.
Thrombosis, purpura, or spontaneous bleeding.
Fever.
Neurological signs (e.g., seizures) in the absence of signs of severe pre-eclampsia.
INVESTIGATIONS
ADAMTS-13 activity assay and inhibitor titres: decreased activity.
Haemolytic uraemic syndrome
SIGNS / SYMPTOMS
Presentation before 20 weeks' gestation.
Microangiopathic haemolytic anaemia in the absence of signs of severe pre-eclampsia.
Thrombosis.
Renal failure in the absence of signs of severe pre-eclampsia.
Diarrhoea (especially bloody diarrhoea), nausea, or vomiting.
INVESTIGATIONS
Peripheral blood smear: presence of schistocytes.
FBC: anaemia, thrombocytopenia.
Chronic kidney disease
SIGNS / SYMPTOMS
History of renal disease before pregnancy.
INVESTIGATIONS
Serum creatinine: elevated in the absence of signs of severe pre-eclampsia.
Liver disease
SIGNS / SYMPTOMS
History of liver disease before pregnancy.
History of alcohol abuse.
Jaundice.
BP is normal.
Hepatomegaly.
INVESTIGATIONS
Urinalysis: absence of proteinuria.
Serum bilirubin: elevated.
Liver function tests: very high in cases of viral disease.
Blood glucose: decreased in cases of acute fatty liver of pregnancy.
Gallbladder disease
SIGNS / SYMPTOMS
History of biliary pain before pregnancy.
Right upper quadrant (RUQ) pain is colicky in nature, and is usually intense, lasting >30 minutes.
BP is normal.
Distended, tender gallbladder may be palpable.
INVESTIGATIONS
Liver function tests: elevated alkaline phosphatase, gamma glutamyl transpeptidase, and bilirubin.
RUQ ultrasound: pericholecystic fluid; distended gallbladder; thickened gallbladder wall; gallstones; positive Murphy sign.
Pancreatic disease
SIGNS / SYMPTOMS
History before pregnancy.
History of alcohol abuse.
BP is normal.
Steatorrhoea.
Jaundice.
Nausea and vomiting.
INVESTIGATIONS
Abdominal ultrasound: structural/anatomical changes including cavities; duct irregularity; contour irregularity of head/body; calcification.
Abdominal CT scan: pancreatic calcifications; focal or diffuse enlargement of the pancreas; ductal dilation; vascular complications.
Abdominal x-ray: pancreatic calcifications.
Serum amylase: elevated.
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