Preclampsia and Eclampsia

Question 1

What is The relationship between the 3 disorders HELLP, Preeclampsia, and Eclampsia?

Answer 1

Preeclampsia: New onset of HTN and proteinuria or end organ dysfunction after 20 weeks gestation in a previously normotensive patent
HELLP: Hemolysis, elevated liver enzymes, low platelets
May be part of severe preeclampsia
May occur without preeclampsia
Eclampsia: Preeclampsia has progressed and the patient now has seizures or coma

Question 2

Preeclampsia Diagnosis

Answer 2

Hypertension
Proteinuria

If they have HTN but no proteinuria will meet criteria for preeclampsia if: 
Low platelets (

Question 3

Preeclampsia Treatment

Answer 3

Delivery especially if after 36 weeks
Epigastic pain, thrombocytopenia and visual disturbances are strong indication for delivery before fetal or maternal demise occurs

Question 4

MILD Preeclampsia Antihypertensive therapy

Answer 4

Hydralazine

Methyldopa

Question 5

HELLP

Answer 5

Hemolysis
Elevated liver enzymes
Low platelets

Question 6

HELLP Diagnosis

Answer 6

Hemolysis:
Abnormal peripheral smear (burr cells and schistocytes or both)
Elevated Bilirubin (>1.2 mg/dl)
Increased Lactic Dehydrogenase (> 600 U/L)
Elevated Liver Enzymes
Low Platelets:

Question 7

Eclampsia emergency care

Answer 7

If patient is convulsing – supportive care

Magnesium sulfate
Watch for signs of magnesium toxicity: Loss of deep tendon reflexes, decrease in respiratory rate and depth
Can be reversed with CALCIUM GLUCONATE