10.1b Preeclampsia and HELLP Flashcards
Preeclampsia
HIGHER IN WOMEN WITH
- Multifetal gestation
- History of preeclampsia
- Chronic hypertension
- Preexisting diabetes
- Preexisting thrombophilia (hypercoagulability)
- Limited sperm exposure with the same partner before conception
Paternal Role in Pre-Eclampsia
- Men who fathered a pre-eclamptic pregnancy are twice as likely to father another pre-eclamptic baby with a different woman
Pre-eclampsia Etiology
- Unknown
- Possibly maladaptive cardiovascular and uteroplacental response to pregnancy
Pre-Eclampsia Pathophysiology
- Caused by disruption in placental perfusion
- In normal pregnancies spiral arteries widen from thick walls to thinner walls which increases its capacity to handle increased blood volumes.
- In pre-eclamptic women, the spiral arteries do not do this which causes decreased placental perfusion and endothelial dysfunction
Placental Ischemia
- Causes endothelial cell injury and vasospasms which results in poor perfusion to all organ systems
- Increased peripheral resistance, BP, endothelial cell permeability, leads to fluid and protein loss (less plasma volume)
- The main issue is not BP but poor perfusion due to vasospasms and reduced plasma volume
Reduced Kidney Perfusion in Pre-Eclampsia
- Decreases GFR rate which can lead to oliguria
- Protein (Albumin) is lost in urine
- Uric acid clearance is decreased (serum uric acid levels is increased)
- Sodium and water are retained
- Tubular necrosis and renal failure may occur
Reduced Kidney Perfusion (cont)
- IVF oncotic pressure is low due to loss of albumin so fluid leaves IVF causing hemoconcentration, increased blood viscosity, and edema
- Hematocrit increases as fluid leaves IVF
- Vasospasm causes endothelial damage, increased capillary permeability, and causes high risk of edema.
Reduced Liver Perfusion Pre-eclampsia
- Elevated liver enzyme levels
- If hepatic edema or subcapsular hemorrhage occur, there may be epigastric/RUQ pain
- Hemorrhagic necrosis in the liver can cause subcapsular hematoma
Preeclampsia Neurologic Complications
- Cerebral Edema/Hemorrhage
- CNS irritability (headaches, hyperreflexia, positive ankle clonus (muscle spasm), seizures
- Decreased blood flow to retina causes blurred/double vision or scotoma (dark spots in field of view)
PreEclampsia Steps
- Inadequate Vascular Remodeling - Spiral Arteries not Dilating
- Decreased placental perfusion and hypoxia
- Endothelial cell Dysfunction
- Vasospasm, Increased Peripheral Resistance, Increased endothelial cell permeability
- Decreased Tissue Perfusion
Risk Factors for Preeclampsia
- Nulliparity
- 40+ y/o
- Pregnancy with assistive reproductive technology
- Family history
- Women who were born small for gestational age
- Obesity/Diabetes
- Multifetal Gestation
- Chronic Hypertension
- History of preeclampsia/poor previous pregnancy/pre-existing conditions
- Renal Disease
- Type 1 Diabetes
- Antiphospholipid Antibody Syndrome
- Factor 5 Leiden Mutation
HELLP Synrome
- Hepatic Dysfunction (Hemolysis) (H)
- Elevated Liver Enzymes (EL)
- Low Platelets (LP)
- Can happen with women who do not have hypertension or proteinuria
- Higher risk in Caucasian women
HELLP Syndrome Risks
- Pulmonary Edema
- Acute Renal Failure
- Disseminated Intravascular Coagulation (DIC)
- Placental Abruption
- Liver Failure/Hemorrhage
- Acute Respiratory Distress Syndrome (ARDS)
- Sepsis
- Stroke
Lab Values
Hemoglobin/Hematocrit
Normal - 12-16 / 47% Preeclampsia - Higher HELLP Syndrome - Lower
Platelets - Lower than 100,000 in both (Normal is 150,000-400,000)
PT/PTT - Unchanged in both (Normal is 12-14 seconds/60-70 seconds)
BUN - Elevated in both (Normal is 10-20)
Creatinine - Normal is 0.5-1.1 mg/dL. Elevated in both
Lactated Dehydrogenase - 45-90 units is normal. Elevated in both
Aspartate Aminotransferase (AST) - Elevated in both
Alanine Aminotransferase (ALT) - Elevated in both
Creatinine Clearance - Normal is 80-125 mL/min
Preeclampsia - 130-180 mL/min HELLP - Lower
Uric Acid Normal 2-6.6. mg/dL
Preeclampsia - >5.9 mg/dL HELLP - >10 mg/dL
Difference between HELLP and Preeclampsia
Hemoglobin/Hematocrit
Preeclampsia (increased) HELLP (decreased)
Creatinine Clearance
Preeclampsia (increased) HELLP (decreased)
Uric Acid
Preeclampsia (>5.9 mg/dL) HELLP (>10 mg/dL)
