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Case 12 · Obstetrics

Severe pre-eclampsia with HELLP syndrome

At 33 weeks a first-time mother has a pounding headache, flashing lights and pain under her right ribs, with BP 168/112 and no fit yet. Prevent eclampsia with magnesium, control BP safely within the hour, recognise HELLP from the bloods, give steroids for the baby, and plan delivery around the platelet count.

PlayableClinical review pendingIntermediateAbout 40–90 simulated minutesHindi · English · both
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About this case

What you will practise

Learning objectives

  • Recognise severe pre-eclampsia and its warning symptoms before the first fit.
  • Give magnesium sulfate to prevent eclampsia, with correct safety monitoring.
  • Treat BP ≥ 160/110 within an hour without dropping it too far.
  • Recognise HELLP syndrome from the blood results and what the platelet count changes.
  • Give antenatal corticosteroids and assess the baby.
  • Plan delivery with the anaesthetist once the mother is stable, avoiding NSAIDs and expectant management.

Key decisions this case tests

  • Magnesium before or after the first fit?
  • How fast should the BP come down, and how far?
  • Spinal or general anaesthesia with platelets of 65,000?
  • When do platelets need transfusing?
  • Wait for the full steroid course, or deliver now?

Reference basis

  • NICE guideline NG133: Hypertension in pregnancy (2019, updated 2023).
  • World Health Organization. Recommendations for prevention and treatment of pre-eclampsia and eclampsia (2011); antenatal corticosteroids (2022).
  • ACOG Practice Bulletin 222 (2020) and Committee Opinion 767 (2019).
  • Magpie Trial Collaborative Group. Lancet 2002;359:1877–90.

Content version 1.0 · November 2026 · clinical review pending. See the Clinical content policy.

Before you start

The physiology is a simplified teaching model: magnesium levels, BP responses, the timing of a first fit and the fall in platelets are timed for learning, not prediction. Doses follow the cited guidelines but have not yet been signed off by a clinician.

Visle is for education only and is not medical advice. Severe headache, visual disturbance or upper abdominal pain in pregnancy is an emergency: get skilled help immediately.

Ready for another emergency?

Case 11 puts you at a birth where the head is out and the shoulders will not follow.

Play Case 11Case library