Eclampsia and HELLP syndrome

Question 1

Eclampsia - definition

Answer 1

Occurrence of tonic-clonic seizure in association with a dx pre-eclampsia
*Obstetric emergency

Question 2

Eclampsia - epidemiology

Answer 2

• Complicates approximately 1-2% of pre-eclamptic pregnancies
• May be the initial presentation of pre-eclampsia, and may occur before hypertension or proteinuria
• Fits may occur antenatally (38%), intrapartum (18%) or postnatally usually within first 48h (44%)

Question 3

HELLP syndrome - definition

Answer 3

Serious complication regarded by most as a variant of severe preeclampsia, which manifests with haemolysis (H), elevated liver enzymes (EL) and low platelets (LP)

Question 4

HELLP syndrome - epidemiology

Answer 4

• Incidence estimated at 5-20% of pre-eclamptic pregnancies

- Maternal mortality estimated at 1%

Question 5

HELLP syndrome - pathophysiology

Answer 5

• Liver enzymes increase and platelets decrease before haemolysis occurs
• Syndrome may be self-limiting, but permanent liver or renal damage may occur

Question 6

HELLP syndrome - symptoms

Answer 6

1. Epigastric or RUQ pain (65%)
2. Nausea and vomiting (35%)
3. Urine is ‘tea-coloured’ due to haemolysis

Question 7

HELLP syndrome - signs

Answer 7

1. Tenderness in RUQ

2. Raised BP and other features of pre-eclampsia

Question 8

Eclampsia - mx

Answer 8

Most eclamptic fits short-lasting and terminate spontaneously

1. Call for help. Airway, breathing and circulation plus IV access
2. First-line drug treatment = MgSO4. Ax reflexes every hour for toxicity, give calcium gluconate if toxicity present
3. If repeated seizures, use diazepam
4. If hypertensive (BP >160/110), give nifedipine, labetalol (avoid in asthmatics)
5. Deliver fetus once mother stable, vaginal delivery not contraindicated if cervix is favourable