Pre-clampsia and Eclampsia Flashcards
- What is preeclampsia?
3 - What is HELLP syndrome?
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(may be a part of what and without what?) - What is eclampsia? 2
1. Preeclampsia New onset of -HTN and -proteinuria or -end organ dysfunction after 20 weeks gestation in a previously normotensive pateint
- HELLP
-Hemolysis,
-elevated liver enzymes,
-low platelets
(May be part of severe preeclampsia and May occur without preeclampsia) - Eclampsia
Preeclampsia has progressed and the patient now has
-seizures or
-coma
The underlying problem is endothelial dysfunction which leads to:
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- Hypertension
- Activation of platelets
- CNS changes
- Edema
- Renal dysfunction resulting in proteinuria
- Hemolysis
- Hepatic ischemia
WHAT CAUSES THE ENDOTHELIAL DYSFUNCTION?
-Many maternal, placental and fetal factors come into play such as?
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-This MAY LEAD TO:
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- Underperfusion of the placenta
- Immunologic factors
- Increased sensitivity to angiotensin II
- Genetic
- Inflammation
- Maternal death (10-15% of maternal deaths)
- Placental abruption
- Acute kidney injury
- Cerebral hemorrhage
- Hepatic failure or rupture
- Pulmonary edema
- DIC
- Eclampsia (seizures)
PREECLAMPSIA-ECLAMPSIA
1. Essentials of dx? 2
- If they have HTN but no proteinuria will meet criteria for preeclampsia if ?
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- Essentials of diagnosis
- Hypertension
- Proteinuria - If they have HTN but no proteinuria will meet criteria for preeclampsia if
-Low platelets ( 1.1 or doubling of the creatinine)
-Elevated liver enzymes (2X the ULN)
-Pulmonary edema
-Cerebral or visual symptoms
(Headache, visual changes)
PREECLAMPSIA-ECLAMPSIA
- Can occur when?
- Only cure?
- Who are most frequently affected?
- What ages are at risk?
- Who else is at risk?
- Can occur anytime after 20 weeks of gestation and up to 6 weeks postpartum
- Only cure is delivery of the fetus and placenta
- Primiparas are most frequently affected
- Extremes of maternal age (less than 20 or older than 35)
- Multiple gestation (twins, triplets)
PREECLAMPSIA-ECLAMPSIA
Associated with? 9
Associated with:
- Chronic HTN,
- diabetes,
- renal disease,
- collagen vascular and
- autoimmune disorders and
- Hydatidiform mole
- New paternity
- Previous preeclampsia or eclampsia or a
- family history
PREECLAMPSIA-ECLAMPSIA
1, Symptoms not evident until when?
2. But when does the process begin?
- Possible cause?
- Symptoms not evident until 3rd trimester but
- process begins as early as 2nd trimester
- Cause:
- Imbalance in placental prostacyclin and thromboxane production
- What is Prostacyclin?
2. Thromboxane?
- = potent vasodilator and inhibitor of platelet aggregation
- = potent vasoconstrictor and stimulates platelet aggregation
PREECLAMPSIA-ECLAMPSIA
1. In a normal pregnancy how do prostacyclin and thromboxane change? 2
- How do they change in preeclampsia?
- What does this result in? 3
- In a normal pregnancy:
- Thromboxane is increased
- Prostacycline levels = thromboxane levels - In Preeclampsia:
Placenta produces 7x more thromboxane than prostacycline - Result:
- Vasoconstriction
- Platelet aggregation
- Reduced uteroplacental blood flow
PREECLAMPSIA-ECLAMPSIA
1. Only cure is what?
- Primary goal of management is to what?
- Important, if possible, to allow what to develop while preventing progression to severe disease and eclampsia?
- Critical factors are what? 3
- delivery of the placenta and fetus
- allow pregnancy to progress as far as possible without jeopardizing maternal or fetal well-being
- fetal lung maturity
- The gestational age of the fetus
- Maturity of fetal lungs
- Severity of maternal disease
- Preeclampsia at 36 weeks or more is managed by what?
- Prior to 36 weeks, severe preeclampsia-eclampsia requires delivery except in unusual circumstances associated with what?
- What are strong indication for delivery? 3
- delivery regardless of how mild the disease is judged
- extreme fetal prematurity, in which case prolongation of pregnancy may attempted
- Epigastic pain,
- thrombocytopenia and
- visual disturbances
MANAGEMENT OF MILD PREECLAMPSIA
1. What may be attempted with mild preeclampsia and a stable home situation?
- Med used? 2
- Does this increase mother or fetal risk?
- Recommended in high risk groups such as? 4
- Home management with bedrest
- -Low dose ASA
60-80 mg/day
-Antihypertensive therapy - No increased maternal or fetal risk
4.
- Women with chronic HTN
- Hx of placental abruption
- PIH in previous pregnancy
- Systemic lupus
MANAGEMENT OF MILD PREECLAMPSIA
- Antihypertensive therapy is used how?
- Which drugs specifically? 2
- To decrease BP enough to protect maternal organs without causing hypotension and threatening fetal oxygen supply
- Hydralazine
- Methyldopa
MODERATE TO SEVERE PREECLAMPSIA
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- Hospitalization for those with moderate or severe preeclampsia
- If patient is far enough along in her pregnancy that the fetus can be delivered safely, then deliver the baby
- If this is not the case the patient needs to be hospitalized and started on a Magnesium Sulfate drip to prevent seizures
MODERATE TO SEVERE PREECLAMPSIA
Regular assessment of what?
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- Blood pressure
- Reflexes
- Urine protein
- FHT and activity
- CBC, platelet count and electrolytes plus liver enzymes q 6. 1-2 days
- 24 hour urine collection for CrCl and protein
- Fetal evaluation
- Daily fetal kick counts
- Consider amniocentesis to evaluate fetal lung maturity if hospitalization occurs at 30-37 weeks.