Mod VIII: Hypertensive Disorders during Pregnancy - Eclampsia - HELLP Syndrome

Question 1

_{Hypertensive Disorders during Pregnancy}

Seizure or convulsion that occur during pregnancy not caused by previous neurologic disease or diagnosis of epilepsy are indicative of which condition?

Answer 1

Eclampsia

Usually preceded by signs of severe preeclampsia

Usually occurs during the 3rd trimester

Life threatening emergency

Question 2

_{Management of Eclampsia}

Management of Eclampsia involves:

Answer 2

Stabilization of mother/seizure control

^{MgSO4 (superior) - Small dose STP/Versed/Valium - Intrauterine resuscitation (LUD)}

^{<strong>Airway management</strong>*}

^{(Airway support vs. intubation - Aspiration precautions)}

Allowed to labor!?*

^{if seizure free, stable, favorable cervix, & reassuring FHT}

Immediate C-section!?*

^{Do not attempted until stable or breakthrough seizures continue}

Question 3

_{Management of Eclampsia}

In the Management of Eclampsia, which drugs and/or therapies are used for Stabilization of mother/seizure control?

Answer 3

MgSO4 (superior)

Small dose STP/Versed/Valium

Intrauterine resuscitation (LUD)

Airway management*

Question 4

_{Management of Eclampsia}

What does Airway management during Stabilization of mother/seizure control as part of the management of eclampsia involves?

Answer 4

Airway support vs. intubation

Aspiration precautions

Question 5

_{Management of Eclampsia}

In the management of Eclampsia, when should labor be allowed to proceed?

Answer 5

Seizure free

Stable - Favorable cervix

Reassuring FHT

Question 6

_{Management of Eclampsia}

In the management of Eclampsia, when is immediate C-section indicated?

Answer 6

If unable to labor

Do not attempted until stable or breakthrough seizures continue

Question 7

_{Management of Eclampsia}

T/F: Guidelines for use of regional vs. GETA in the Management of Eclampsia are similar to pt with severe preeclampsia

Answer 7

True

Question 8

_{HELLP Syndrome}

What does HELLP Syndrome stands for?

Answer 8

Hemolysis, Elevated Liver enzymes, Low Platelets

HELLP

Question 9

_{HELLP Syndrome}

What’s the pathophysiologic mechanism of HELLP Syndrome?

Answer 9

Micro-angiopathic hemolytic anemia

whereby RBCs fragment while passing through vessels with endothelial damage

Question 10

_{HELLP Syndrome}

What’s the incidence of HELLP Syndrome?

Answer 10

4-12% in parturient with preeclampsia or eclampsia

0.2-0.4% of all pregnancies

Question 11

_{HELLP Syndrome}

When does HELLP Syndrome occur?

Answer 11

Mostly during 3rd trimester

Can also occur Postpartum

^{Onset typically within first 48hrs after delivery - May not become apparent until 7days after}

Question 12

_{HELLP Syndrome}

Risk factors of HELLP Syndrome

Answer 12

Multiparous

Maternal age > 25 years

White race

(differ from preeclampsia)

Question 13

_{HELLP Syndrome}

Clinical presentation of HELLP Syndrome

Answer 13

Malaise

Epigastric pain

N/V - HA - HTN

Proteinuria are absent or mild

Question 14

_{HELLP Syndrome}

The presentation of HELLP Syndrome could be Variable in nature, which could make it be misdiagnosed for:

Answer 14

Cholecystitis

Esophagitis

Gastritis

ITP

Question 15

_{HELLP Syndrome}

Treatment of HELLP Syndrome involves:

Answer 15

Prompt delivery is NOT required

Tx is Conservative

^{based on gestational age and maternal/fetal condition}

Goals are similar to Tx of preeclampsia

^{Control HTN, MgSO4, high-dose steroids (helps mature fetal lungs and treats the mother), monitoring PLT/LFT’s, oliguria responds to fluid management}

Delivery

^{C-section not mandatory}

^{Labor tried if mild form of HELLP syndrome (stable, favorable cervix, >32 weeks gestation)}

Question 16

_{HELLP Syndrome}

T/F: Anesthetic management of HELLP Syndrome is identical to preeclampsia

Answer 16

True