"...Death from preeclampsia at 15 weeks gestation would be very unusual..."

Q:  I am a police investigator who was called to the scene of a 33 year-old female 15 weeks pregnant who was found deceased.  She had three other children ages 2, 5, and 6.  No history of HELLP or preeclampsia and no problems with her three previous pregnancies.  No problems with her current pregnancy as reported by her doctor.  An autopsy revealed no known reason for her death and the toxicology results are still pending.  She had been sick the past few days with a headache and a slight fever but didn't go see her doctor.  She went to bed and was reported to be restless and then was found in the morning deceased.  The medical examiner is leaning toward HELLP syndrome at this time because she had two symptoms - headache and nausea.  The blood test revealed low platelet count or a problem with liver function.  I have been reading up on this syndrome and it seems to happen at the end of the second trimester or third trimester.  It is also associated with preeclampsia. I have heard it can happen prior to 20 weeks with kidney disease and a history of birth problems or pregnancy problems, which didn't occur in this case.  Do you have any statistics on HELLP happening before 20 weeks and with what circumstances?

A:  Death from preeclampsia at 15 weeks gestation would be very unusual.  Usually, when a woman dies from HELLP, there is secondary evidence of the cause of death:  (e.g. cerebral edema, intracerebral hemorrhage, pulmonary edema.)  Any of these would be observed by the pathologist.  Most women with preeclampsia will have abnormal kidneys when examined under the microscope.

Without some clear finding, it would be hard to attribute the death to HELLP.