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OB/GYN > Pre-eclampsia, Eclampsia, & HELLP Syndrome > Flashcards

Pre-eclampsia, Eclampsia, & HELLP Syndrome Flashcards

1
Q

Pre-eclampsia

A

New onset HTN & proteinuria or end organ dysfunction after 20 weeks gestation in a previously normotensive patient

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2
Q

Eclampsia

A

Pre-eclampsia has progressed & patient now has seizures or coma

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3
Q

HELLP Syndrome

A

Hemolysis
Elevated liver enzymes
Low platelets

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4
Q

Pathogenesis of Pre-eclampsia, Eclampsia, HELLP Syndrome

A 
Endothelial dysfunction*
HTN
Activation of platelets
CNS changes
Edema
Renal dysfunction resulting in proteinuria
Hemolysis
Hepatic ischemia
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5
Q

Causes of Endothelial Dysfunction

A

Under perfusion of the placenta
Immunologic factors
Increased sensitivity to angiotensin II
Genetic Inflammation

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6
Q

Endothelial Dysfunction May Lead To

A 
Maternal death
Placental abruption
Acute kidney injury
Cerebral hemorrhage
Hepatic failure or rupture
Pulmonary edema
DIC
Eclampsia (seizures)
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7
Q

Essentials of Diagnosis of Pre-eclampsia-Eclampsia

A

HTN

Proteinuria

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8
Q

Pre-eclampsia Criteria if HTN but no Proteinuria

A

Low platelets (

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9
Q

Who is most frequently affected by pre-eclampsia-eclampsia?

A

Women with their first pregnancy

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10
Q

Risk Factors of Pre-Eclampsia/Eclampsia

A

Extremes of maternal age (35)

Multiples

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11
Q

Pre-Eclampsia & Eclampsia Associated With

A 
Chronic HTN
DM
Renal disease
Collagen disorders
Vascular disorders
Autoimmune disorders
Hydatidiform mole
New paternity
Previous pre-eclampsia or eclampia
Family history
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12
Q

Cause of Pre-Eclampsia/Eclampsia

A

Imblance in placental prostacyclin & thromboxane production

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13
Q

Function of Prostacyclin

A

Potent vasodilator & inhibitor of platelet aggregation

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14
Q

Function of Thromboxane

A

Potent vasoconstrictor & stimulates platelet aggregation

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15
Q

Normal Pregnancy Prostacycline & Thromboxane Levels

A

Prostacyclin levels = thromboxane levels

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16
Q

Pre-Eclampsia Prostacyclin & Thromboxane Levels

A

Placenta produces 7x more thromboxane than prostaglandin

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17
Q

Result of 7x more Thromboxane levels that Prostaglandin Levels

A

Vasoconstriction
Platelet aggregation
Reduced uteroplacental blood flow

18
Q

Delivery of Pre-Eclampsia/Eclampsia

A

Allow pregnancy to progress as far as possible

Lung development of the fetus

19
Q

Critical Factors of Delivery in Pre-Eclampsia/Eclampsia

A

Gestational age of fetus
Maturity of fetal lungs
Severity of maternal disease

20
Q

Treatment of Pre-Eclampsia at 36 Weeks

A

Delivery

21
Q

Treatment of Pre-Eclampsia Prior to 36 weeks

A

Severe: delivery

22
Q

What Signs/Symptoms are Strong Indicators for Delivery with Pre-Eclampsia/Eclampsia

A

Epigastric pain
Thrombocytopenia
Visual disturbances

23
Q

Management of Mild Pre-Eclampsia

A

Best rest
Low dose ASA
Antihypertensive therapy

24
Q

ASA in High Risk Groups of Pre-Eclampsia

A

Chronic HTN
Hx of placental abruption
PIH in previous pregnancy
Systemic lupus

25
Q

Antihypertensive Therapy in the Management of Mild Pre-Eclampsia

A

Hydralazine

Methyldopa

26
Q

Management of Moderate to Severe Pre-Eclampsia

A

Hospitalization
Far enough along: delivery baby
Not far enough along: place on magnesium sulfate drip to prevent seizures

27
Q

Regular Assessment of Pre-Eclampsia

A 
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
28
Q

Steroids for Mom to Help with Fetal Lung Development

A

Betamethasone (Diprolene)

Dexamethasone (Decadron)

29
Q

Severe Pre-Eclampsia

A

BP: 160+/110+
Proteinuria: >500 mg/day
Oliguria:

30
Q

Systemic Associations with Severe Pre-Eclampsia

A

Renal insufficiency
Placenta abruption
Pulmonary edema & pulmonary HTN due to decreased cardiac output
CNS: petechial hemorrhages

31
Q

HELLP Syndrome

A

Hemolysis
Elevated Liver enzymes
Low Platelets

32
Q

Signs/Symptoms of HELPP Syndrome

A 
BP mildly elevated
Proteinuria +/-
Edema
Malaise
Epigastric pain
Nausea with/without vomiting
RUQ tenderness
33
Q

HELLP Diagnosis

A

Hemolysis: peripheral smear (schistocytes, burr cells)
Elevated Liver enzymes: SGOT >70 U/L, LDH >600 U/L
Low Platelets:

34
Q

HELLP Complications

A 
Placental abruption
Acute renal failure
Hepatic hematoma
Liver rupture
Ascites
Hemorrhage
Fetal death
Maternal death
35
Q

Management of HELLP

A

Delivery

36
Q

Difference Between Pre-Eclampsia & Eclampsia

A

Seizure activity

37
Q

Eclampsia Emergency Care

A

Supportive if convulsing

Magnesium sulfate: control seizure activity

38
Q

Magnesium Sulfate

A 
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
39
Q

Signs of Magnesium Sulfate Toxicity

A

Loss of DTRs

Decrease in RR & depth

40
Q

Reversal Agent for Magnesium Sulfate Toxicity

A

Calcium Gluconate

41
Q

Treatment of Eclampsia

A

Delivery

Continue Magnesium sulfate until postpartum resolution (diuresis most reliable indicator)

42
Q

After Pre-Eclampsia/Eclampsia

A

Most women return to normotensive state
Increased risk with multiple pregnancies
Some women develop chronic, manageable HTN

OB/GYN (12 decks)

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