Pre-Eclampsia and HELLP Syndrome

Question 1

What is pre-eclampsia?

Answer 1

• New onset hypertension after 20 weeks
• Proteinuria
• Maternal organ dysfunction

Question 2

What is HELLP syndrome?

Answer 2

• Severe form of pre eclampsia characterised by
• Haemolysis
• Elevate liver enzymes
• Low platelet count

Question 3

What is eclampsia?

Answer 3

• Occurrence of seizures in women with eclampsia

Question 4

Identify 3 risk factors for pre-eclampsia

Answer 4

• Hypertension during previous pregnancy
• CKD
• Autoimmune disease
• Diabetes
• Chronic hypertension
• Age 40 years or older

Question 5

Identify three complications of pre-eclampsia

Answer 5

• CNS complications: Haemorrhage, infarction and oedema
• Respiratory complications: ARDS, oedema
• Hepatic complications: Rupture and failure
• Foetal complications: Placental abruption, preterm delivery, stillbirth

Question 6

Identify three clinical features of pre-eclampsia

Answer 6

• Hyper-reflexia
• Headache
• RUQ brain
• Breathlessness

Question 7

Identify an investigation used to help diagnose pre-eclampsia

Answer 7

• Urinalysis: Protein:creatine ratio greater than 30 mg/mol

Question 8

Identify three additional investigations to help diagnose HELLP syndrome

Answer 8

• FBC: Reduced Hb; Thrombocytopenia
• LFTs: Elevated
• Peripheral blood film: Schistocytes; Burr cells

Question 9

Identify three foetal investigations in suspected pre-eclampsia

Answer 9

• Cardiotocography
• Foetal ultrasound
• Umbilical artery doppler velocimetry

Question 10

Identify three differential diagnoses of pre-eclampsia

Answer 10

• Gestational hypertension
• Antiphospholipid syndrome
• Thrombotic thrombocytopenic purpura
• Haemolytic uraemic syndrome
• Acute fatty liver of pregnancy

Question 11

How should a woman at high risk of pre-eclampsia (previous hypertension in pregnancy) be managed?

Answer 11

• Aspirin 75 mg from 12 weeks gestation

Question 12

Outline the management of pre-eclampsia

Answer 12

• Hospital admission
• Deliver the baby if symptomatic
• IV labetalol to reduce BP
• Corticosteroid before 34 weeks to mature foetal lungs

Question 13

Outline the management of HELLP syndrome-

Answer 13

• Delivery baby
• Corticosteroid before 34 weeks to mature foetal lungs
• Platelet transfusions
• FFP

Question 14

Outline the management of eclampsia

Answer 14

• IV magnesium sulfate

Question 15

How should magnesium sulfate induced respiratory depression be treated?

Answer 15

• Calcium gluconate

Question 16

Identify four indications for delivery

Answer 16

• Gestational age 38 weeks
• Symptomatic pre-eclampsia
• HELLP syndrome
• Suspected placental abruption