Differential Diagnosis for Preeclampsia

When considering the diagnosis of preeclampsia in a pregnant woman, it's crucial to evaluate various conditions that could present with similar symptoms. The differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Preeclampsia: This condition is characterized by the onset of hypertension and often proteinuria after 20 weeks of gestation in a previously normotensive woman. It is a leading cause of maternal and fetal morbidity and mortality worldwide. The presentation of high blood pressure and signs of end-organ damage (such as protein in the urine) makes preeclampsia the most likely diagnosis if these criteria are met.

• Other Likely Diagnoses

  • Chronic Hypertension: This condition can be pre-existing before pregnancy or develop before 20 weeks of gestation. Distinguishing between chronic hypertension and preeclampsia is crucial, as management strategies differ.
  • Gestational Hypertension: This condition involves the onset of hypertension after 20 weeks of gestation without proteinuria or other signs of preeclampsia. It can sometimes evolve into preeclampsia.
  • Pregnancy-Induced Hypertension: A term sometimes used interchangeably with gestational hypertension, though it may encompass a broader range of conditions including preeclampsia.

• Do Not Miss Diagnoses

  • Eclampsia: A severe complication of preeclampsia characterized by the onset of seizures in a woman with preeclampsia. It is a medical emergency.
  • HELLP Syndrome: A variant of preeclampsia characterized by Hemolysis, Elevated Liver enzymes, and Low Platelet count. It can rapidly progress to severe complications, including liver rupture and disseminated intravascular coagulation.
  • Acute Kidney Injury: Preeclampsia can cause kidney damage, leading to acute kidney injury. Recognizing this complication is crucial for appropriate management.
  • Pulmonary Edema: Fluid accumulation in the lungs can occur due to the capillary leak associated with preeclampsia, leading to respiratory distress.

• Rare Diagnoses

  • Posterior Reversible Encephalopathy Syndrome (PRES): A rare condition associated with preeclampsia, characterized by neurological symptoms and specific findings on MRI. It is reversible with appropriate management.
  • Thrombotic Thrombocytopenic Purpura (TTP): A rare blood disorder that can mimic some symptoms of preeclampsia, such as thrombocytopenia and renal dysfunction.
  • Hemolytic Uremic Syndrome (HUS): Similar to TTP, HUS is a rare condition that can present with thrombocytopenia, renal failure, and hemolytic anemia, and must be distinguished from preeclampsia and HELLP syndrome.

Each of these conditions requires careful consideration and evaluation to ensure accurate diagnosis and appropriate management, given the potential for severe maternal and fetal complications.