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Preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome remain as major obstetric problems that plague a large percentage of women resulting in an equally large percentage of maternal and perinatal morbidities. It is important that a clinician makes the most accurate diagnosis possible to prevent these adverse maternal and perinatal outcomes. In general, most women will have a classical presentation of preeclampsia (hypertension and proteinuria) at >20 weeks gestation and <48 hours postpartum. However, recent studies have suggested that some women will develop preeclampsia without the classical findings. The purpose of this review is to increase awareness of the non-classical and atypical features of preeclampsia, eclampsia, and HELLP syndrome and their respective management. Atypical cases are those that develop before 20 weeks, beyond 48 hours postpartum and those that present with some of the signs and symptoms of preeclampsia without the usual hypertension or proteinuria. By formulating a rational stepwise approach towards diagnosis, we may prevent the costly consequence of a missed diagnosis and its eventual possible fatalities.

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trophoblastic inclusions, and fetal or embryonic tissue; they usually have a triploid karyotype.Ultrasound technology allows the diagnosis of molar pregnancy to be made in the first trimester before classic signs and symptoms (excessive uterine size, anemia, toxemia, or hyperemesis) arise. Ultrasound findings of complete moles during the first trimester will show less cavitation and have smaller villi than complete moles found in the second trimester. An elevated human chorionic gonadotropin (hCG) level can distinguish an early complete mole from a missed abortion, especially when levels are greater than 100,000 mIU/mL. A partial mole is characterized by ultrasound findings that show focal cystic changes in the placenta and a gestational sac with a ratio of the transverse to anteroposterior dimension of greater than 1.5. Levels of hCG greater than 100,000 mIU/mL at presentation are seen less frequently in patients with partial moles. More accurate pathologic diagnosis using flow cytometry to determine ploidy can determine whether the mole is diploid or triploid and whether the biomarkers of paternally imprinted and maternally expressed gene products are present.Patients with molar pregnancies should be assessed for anemia, toxemia, and hyperthyroidism. Laboratory values for blood type, hematocrit, and thyroid, liver, and renal functions should be obtained. Suction curettage is the optimal method for evacuation of the mole if a patient wants to retain reproductive capabilities. Patients who do not want future children can undergo hysterectomy; hCG levels should be monitored after procedure because metastatic disease beyond the uterus and persistent neoplasia can develop. Rh-immune globulin should be administered in Rh-negative patients. Criteria for the diagnosis of persistent neoplasia include serum hCG levels that do not return to the normal range after evacuation of the mole, evidence of metastasis, and a pathologic diagnosis of choriocarcinoma within the molar tissue. Chemotherapy offers cure rates of 80% to 100% for nonmetastatic and metastatic diseases. In a study of 858 patients with a complete mole, persistent tumor after evacuation was more likely among patients with signs of marked trophoblastic proliferation, an hCG level greater than 100,000 mIU/mL, a uterine size that was larger than appropriate for the gestational age, and theca lutein ovarian cysts greater than 6 cm in diameter. The risk of gestational trophoblastic neoplasia after a partial molar pregnancy is 0% to 11%. As the development of a new fetus during follow-up testing could interfere with testing of hCG levels, patients with a molar pregnancy should use contraception during the monitoring process. The risk of a subsequent pregnancy being molar is approximately 1% after 1 mole and approximately 15% to 18% after 2 moles. A first trimester ultrasound examination is recommended in subsequent pregnancies.The required duration for follow-up hCG testing and whether prophylactic chemotherapy should be administered at the time of evacuation are un...