Pre-eclampsia, Eclampsia, & HELLP Syndrome Flashcards
Pre-eclampsia
New onset HTN & proteinuria or end organ dysfunction after 20 weeks gestation in a previously normotensive patient
Eclampsia
Pre-eclampsia has progressed & patient now has seizures or coma
HELLP Syndrome
Hemolysis
Elevated liver enzymes
Low platelets
Pathogenesis of Pre-eclampsia, Eclampsia, HELLP Syndrome
Endothelial dysfunction* HTN Activation of platelets CNS changes Edema Renal dysfunction resulting in proteinuria Hemolysis Hepatic ischemia
Causes of Endothelial Dysfunction
Under perfusion of the placenta
Immunologic factors
Increased sensitivity to angiotensin II
Genetic Inflammation
Endothelial Dysfunction May Lead To
Maternal death Placental abruption Acute kidney injury Cerebral hemorrhage Hepatic failure or rupture Pulmonary edema DIC Eclampsia (seizures)
Essentials of Diagnosis of Pre-eclampsia-Eclampsia
HTN
Proteinuria
Pre-eclampsia Criteria if HTN but no Proteinuria
Low platelets (
Who is most frequently affected by pre-eclampsia-eclampsia?
Women with their first pregnancy
Risk Factors of Pre-Eclampsia/Eclampsia
Extremes of maternal age (35)
Multiples
Pre-Eclampsia & Eclampsia Associated With
Chronic HTN DM Renal disease Collagen disorders Vascular disorders Autoimmune disorders Hydatidiform mole New paternity Previous pre-eclampsia or eclampia Family history
Cause of Pre-Eclampsia/Eclampsia
Imblance in placental prostacyclin & thromboxane production
Function of Prostacyclin
Potent vasodilator & inhibitor of platelet aggregation
Function of Thromboxane
Potent vasoconstrictor & stimulates platelet aggregation
Normal Pregnancy Prostacycline & Thromboxane Levels
Prostacyclin levels = thromboxane levels
Pre-Eclampsia Prostacyclin & Thromboxane Levels
Placenta produces 7x more thromboxane than prostaglandin
Result of 7x more Thromboxane levels that Prostaglandin Levels
Vasoconstriction
Platelet aggregation
Reduced uteroplacental blood flow
Delivery of Pre-Eclampsia/Eclampsia
Allow pregnancy to progress as far as possible
Lung development of the fetus
Critical Factors of Delivery in Pre-Eclampsia/Eclampsia
Gestational age of fetus
Maturity of fetal lungs
Severity of maternal disease
Treatment of Pre-Eclampsia at 36 Weeks
Delivery
Treatment of Pre-Eclampsia Prior to 36 weeks
Severe: delivery
What Signs/Symptoms are Strong Indicators for Delivery with Pre-Eclampsia/Eclampsia
Epigastric pain
Thrombocytopenia
Visual disturbances
Management of Mild Pre-Eclampsia
Best rest
Low dose ASA
Antihypertensive therapy
ASA in High Risk Groups of Pre-Eclampsia
Chronic HTN
Hx of placental abruption
PIH in previous pregnancy
Systemic lupus
Antihypertensive Therapy in the Management of Mild Pre-Eclampsia
Hydralazine
Methyldopa
Management of Moderate to Severe Pre-Eclampsia
Hospitalization
Far enough along: delivery baby
Not far enough along: place on magnesium sulfate drip to prevent seizures
Regular Assessment of Pre-Eclampsia
BP Reflexes Urine protein FHT & activity CBC Platelet count Electrolytes Liver enzymes 24 urine collection for CrCl & protein Fetal evaluation Daily fetal kick counts Consider amniocentesis
Steroids for Mom to Help with Fetal Lung Development
Betamethasone (Diprolene)
Dexamethasone (Decadron)
Severe Pre-Eclampsia
BP: 160+/110+
Proteinuria: >500 mg/day
Oliguria:
Systemic Associations with Severe Pre-Eclampsia
Renal insufficiency
Placenta abruption
Pulmonary edema & pulmonary HTN due to decreased cardiac output
CNS: petechial hemorrhages
HELLP Syndrome
Hemolysis
Elevated Liver enzymes
Low Platelets
Signs/Symptoms of HELPP Syndrome
BP mildly elevated Proteinuria +/- Edema Malaise Epigastric pain Nausea with/without vomiting RUQ tenderness
HELLP Diagnosis
Hemolysis: peripheral smear (schistocytes, burr cells)
Elevated Liver enzymes: SGOT >70 U/L, LDH >600 U/L
Low Platelets:
HELLP Complications
Placental abruption Acute renal failure Hepatic hematoma Liver rupture Ascites Hemorrhage Fetal death Maternal death
Management of HELLP
Delivery
Difference Between Pre-Eclampsia & Eclampsia
Seizure activity
Eclampsia Emergency Care
Supportive if convulsing
Magnesium sulfate: control seizure activity
Magnesium Sulfate
Given as bolus with continuous IV infusion Blood levels checked every 4-6 hours Urine output checked hourly Watch for signs of toxicity Readily crosses placenta
Signs of Magnesium Sulfate Toxicity
Loss of DTRs
Decrease in RR & depth
Reversal Agent for Magnesium Sulfate Toxicity
Calcium Gluconate
Treatment of Eclampsia
Delivery
Continue Magnesium sulfate until postpartum resolution (diuresis most reliable indicator)
After Pre-Eclampsia/Eclampsia
Most women return to normotensive state
Increased risk with multiple pregnancies
Some women develop chronic, manageable HTN
