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