Differentials
Chronic hypertension
SIGNS / SYMPTOMS
Preexisting 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 neurologic 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 ischemic attack.
INVESTIGATIONS
Lupus anticoagulant: positive.
Anticardiolipin antibodies: medium or high titer.
Anti-beta-2-glycoprotein I: titer >99th percentile.
Thrombotic thrombocytopenic purpura
SIGNS / SYMPTOMS
Presentation before 20 weeks' gestation.
Thrombosis, purpura, or spontaneous bleeding.
Fever.
Neurologic signs (e.g., seizures) in the absence of signs of severe preeclampsia.
INVESTIGATIONS
ADAMTS-13 activity assay and inhibitor titers: decreased activity.
Hemolytic uremic syndrome
SIGNS / SYMPTOMS
Presentation before 20 weeks' gestation.
Microangiopathic hemolytic anemia in the absence of signs of severe preeclampsia.
Thrombosis.
Renal failure in the absence of signs of severe preeclampsia.
Diarrhea (especially bloody diarrhea), nausea, or vomiting.
INVESTIGATIONS
Peripheral blood smear: presence of schistocytes.
CBC: anemia, thrombocytopenia.
Chronic kidney disease
SIGNS / SYMPTOMS
History of renal disease before pregnancy.
INVESTIGATIONS
Serum creatinine: elevated in the absence of signs of severe preeclampsia.
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.
Steatorrhea.
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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