Table 15.3-10. Investigations for evidence of end-organ dysfunction

Diagnostic test

Red flags


Anemia if hemolysis is present, thrombocytopenia


Elevation of transaminases can occur in both preeclampsia and other causes of HELLP syndrome

Creatinine, uric acid

Baseline creatinine values in pregnancy are decreased. Elevations may be reported as “normal”; therefore, it is helpful to have a prepregnancy/early pregnancy value

LDH, bilirubin

Elevated if hemolysis is present


Any increase suggests coagulation factor deficit. INR >1.3 suggests serious liver disease (consider acute fatty liver of pregnancy)

Placental growth factor

Not currently available in Canada

Midstream urine

Evidence of proteinuria or hematuria

Urine PCR or 24-h urine collection for protein

24-h urine >0.3 g/d or PCR >30 mg/mmol

ECG, chest radiography, troponin

Warranted if chest pain, shortness of breath, or other clinical signs suggestive of ischemia, edema, or ventricular depression are present. Consider in the case of a first presentation of hypertension to investigate for evidence of chronicity or underlying structural heart disease

Fetal and uterine artery ultrasonography

Fetal growth restriction, abnormal heart rate, stillbirth; abnormal uterine artery flow

ALT, alanine aminotransferase; AST, aspartate aminotransferase; CBC, complete blood count; ECG, electrocardiography; HELLP, hemolysis, elevated liver enzymes, low platelets; INR, international normalized ratio; LDH, lactate dehydrogenase; PCR, protein-to-creatinine ratio.