Differential Diagnosis

Differential Diagnosis

The differential diagnosis will differ depending on the presenting symptoms/signs.2

 
Presentation Differential diagnosis Differentiating features
Hypertension Chronic hypertension   Pre-existing hypertension, absence of new onset proteinuria
Gestational hypertension New onset hypertension, no proteinuria or other features of pre-eclampsia
Headaches/ visual disturbance  Anti-phospholipid syndrome Possible history of recurrent miscarriage/VTE/stroke/TIAs
 Thrombotic thrombocytopaenia purpura May have some/all of fever/confusion/low platelets/renal failure/haemolytic anaemia
Cerebral venous sinus thrombosis Absence of hypertension, progressive severe headache, neurological deficits 
Seizures  Epilepsy Previous diagnosis of epilepsy or previous seizure, absence of hypertension/proteinuria 
Thrombotic thrombocytopaenia purpura May have some/all of fever/confusion/low platelets/renal failure/haemolytic anaemia
Cerebral haemorrhage Patients with uncontrolled hypertension are at risk of cerebral haemorrhage. 
Abdominal pain/vomiting HELLP syndrome  May not have high BP or proteinuria. Haemolysis/thrombocytopaenia/ elevated liver transaminases
Acute fatty liver of pregnancy Part of pre-eclampsia spectrum. Differentiate from HELLP syndrome by hypoglycaemia which is a feature of AFLP but not HELLP.
Gallbladder disease Colicky, RUQ pain, normal BP/urinalysis. LFTs may show raised bilirubin/ALP, USS showing gallstones. 
Pancreatitis Previous history of pancreatitis/alcohol excess, normal BP, raised amylase/USS suggesting pancreatitis. 
Haemolytic uraemic syndrome  Bloody diarrhoea, microangiopathic haemolytic anaemia, low platelets/AKI

Learning bite

There is a wide differential diagnosis for pre-eclampsia that needs to be considered to prevent other serious diagnoses being missed .