10.1b Preeclampsia and HELLP Flashcards

1
Q

Preeclampsia

A

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
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2
Q

Paternal Role in Pre-Eclampsia

A
  • Men who fathered a pre-eclamptic pregnancy are twice as likely to father another pre-eclamptic baby with a different woman
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3
Q

Pre-eclampsia Etiology

A
  • Unknown

- Possibly maladaptive cardiovascular and uteroplacental response to pregnancy

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4
Q

Pre-Eclampsia Pathophysiology

A
  • 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
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5
Q

Placental Ischemia

A
  • 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
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6
Q

Reduced Kidney Perfusion in Pre-Eclampsia

A
  • 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
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7
Q

Reduced Kidney Perfusion (cont)

A
  • 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.
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8
Q

Reduced Liver Perfusion Pre-eclampsia

A
  • 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
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9
Q

Preeclampsia Neurologic Complications

A
  • 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)
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10
Q

PreEclampsia Steps

A
  1. Inadequate Vascular Remodeling - Spiral Arteries not Dilating
  2. Decreased placental perfusion and hypoxia
  3. Endothelial cell Dysfunction
  4. Vasospasm, Increased Peripheral Resistance, Increased endothelial cell permeability
  5. Decreased Tissue Perfusion
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11
Q

Risk Factors for Preeclampsia

A
  • 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
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12
Q

HELLP Synrome

A
  • 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
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13
Q

HELLP Syndrome Risks

A
  • Pulmonary Edema
  • Acute Renal Failure
  • Disseminated Intravascular Coagulation (DIC)
  • Placental Abruption
  • Liver Failure/Hemorrhage
  • Acute Respiratory Distress Syndrome (ARDS)
  • Sepsis
  • Stroke
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14
Q

Lab Values

A

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

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15
Q

Difference between HELLP and Preeclampsia

A

Hemoglobin/Hematocrit
Preeclampsia (increased) HELLP (decreased)

Creatinine Clearance
Preeclampsia (increased) HELLP (decreased)

Uric Acid
Preeclampsia (>5.9 mg/dL) HELLP (>10 mg/dL)

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