HELLP syndrome

A 28-year-old woman comes together with her partner to the Department of Gynaecology and Obstetrics at the local hospital. The woman is 26 weeks pregnant, presents with a strong and sudden epigastric pain and right upper quadrant tenderness. She describes the pain as dull and persistent. Furthermore, she complains of nausea, vomiting and severe headache. How do you proceed?
Help
You prescribe painkillers to relieve the headache and recommend her to make an appointment with her gynaecologist 10 days from now.
You take patient’s medical history, measure blood pressure, perform fetal ultrasound and CTG, take peripheral blood samples for laboratory testing and urine for chemical analysis.
You take patient’s medical history, measure blood pressure, perform fetal ultrasound. Then you decide to hospitalise the patient for a couple of days. In case of high blood pressure, you administer antihypertensive medication, in case of persisting difficulties, especially lasting headache, you ask for a neurological consultation.
You are probably dealing with gastroenteritis, the best solution is to perform fetal ultrasound and dispatch the patient to the Department of Gastroenterology for further examination.
28
years
woman
RR
17 /min
HR
88 /min
BP
160/111 (127) mmHg
Examination
Physical Exam:
General: conscious, no apparent distress, oriented, cooperating
Skin: warm, pink, slightly sweaty
Pulm: clear to auscultation bilateraly
Cardiac: regular rate and rhythm, tachycardia 90 bpm
Abdomen: right upper quadrant tenderness
Extremities: no edema

Vaginal exam: normal findings; Cervix score: 0