Preeclampsia Eclampsia HELLP Flashcards
What is the relationship between preeclampsia, HELLP, and eclampsia?
Preeclampsia is new onset HTN and proteinuria/end organ dysfunction after 20wks gestation.
HELLP may be part of severe preeclampsia or it may occur on its own.
Eclampsia is preeclampsia that has progressed to seizures or coma.
Pathogenesis of these three disorders?
underlying problem is endothelial dysfunction leading to..
- HTN
- activation of platelets
- CNS changes
- edema
- renal dysfunction resulting in proteinuria
- hemolysis
- hepatic ischemia
endothelial dysfunction may be caused by:
- underperfusion of placenta
- immunologic factors
- increased sensitivity to angiotensin II
- genetic
- inflammation
These three conditions may lead to what?
maternal death
placental abruption
acute kidney injury
cerebral hemorrhage (multifocal petechial hemorrhages of grey/white matter junction)
hepatic failure/rupture
pulmonary edema/HTN
DIC
eclampsia
Preeclampsia:
- dx
- what time frame of pregnancy is this MC?
- tx
- risk factors
Dx:
- HTN* (greater than 140/90)
- proteinuria*
- if they have HTN but no proteinuria they need:
- -low platelets less than 100K
- -elevated serum creatinine
- -elevated liver enzymes
- -pulmonary edema
- -cerebral or visual sx (HA, visual changes)
MC occurs after 20wks gestation and up to 6wks post partum
Tx: delivery of fetus and placenta
*primary goal is to allow pregnancy to progress as far as possible without jeopardizing maternal or fetal well being.
Risk factors:
- extremes of maternal age (less than 20 or older than 35)
- multiple gestation (twins, triplets)
- primiparas
Preeclampsia
-associations
Associated with:
- chronic HTN, DM, renal dz, collagen vascular and autoimmune disorders, hydatidiform mole
- previous preeclampsia/eclampsia
Preeclampsia:
- when are sx most evident?
- is the result of a placental imbalance of what? What is the normal balance?
-Sx not evident until 3rd trimester but process begins as early as 2nd trimester.
Placental imbalance of prostacyclin and thromboxane production.
- prostacyclin=vasodilatr and inhibits platelet aggregation
- thromboxane=potent vasoconstrictor and stimulates platelet aggregation
- In preeclampsia the placenta produces 7X MORE THROMBOXANE than prostacycine resulting in vasoconstriction, platelet aggregation, and reduced uroplacental blood flow.
*In normal pregnancy Thromboxane = prostacycline levels
Preeclampsia: What is the tx given each of the following circumstances…
- at 36wks gestation
- before 36wks gestation w/ severe preeclampsia
- epigastric pain, thrombocytopenia, and visual disturbances
36 wks gestation: deliveery regardless of how mild the dz is judged
before 36wks and severe: delivery
epigastric pain, thrombocytopenia, and visual disturbances: strong indication for delivery
Management of MILD preeclampsia
bedrest
low dose ASA (60-80mg/day)
Antihypertensive therapy: hydralazine, methyldopa
Management of MODERATE/SEVERE preeclampsia?
hospitilization
deliver baby if far enough along in pregnancy that fetus can be safely delivered.
*if unable to delivery pt needs to be started on magnesium sulfate to prevent seizures.
Assessment of:
- blood pressure
- Reflexes*
- urine protein
- FHT and activity
- CBC (plateles, electrolyte count, liver)
- 24hr urine collection for CrCl and protein
Evaluate fetal lung maturity if hospitilzation occurs 30-37wks
Steroids: Betamethsone (Diprolene), Dexamethasone (Decardron) for fetal lung development, esp if between 26-30wks
Dx/Signs of severe Preeclampsia
BP greater than 160/110
proteinuria greater than 500mg/24hrs or 4+ on dipstick
oliguria of less than 500ml/24hrs
thrombocytopenia
HELLP:
- hemolysis (see schistocytes on peripheral smear)
- elevated liver enzymes
- low platelets
- fetal growth restriction
- renal insufficiency
HELLP:
- characterized by?
- signs an sx
- dx
Characterized:
- hemolysis
- elevated liver enzymes
- low platelets
Signs and sx:
- BP mildly elevated
- proteinuria +/-
- edema
- malaise
- epigastric pain
- nause +/- vomiting
- RUQ tenderness.
Dx:
-hemolysis: (peripheral smear = burr/echinocyte and schistocytes) elevated bilirubin, increased lactate dehydrogenase
- elevated liver enzymes
- low platelets (less than 100,00)
HELLP
- complications
- management
Complications:
- placental abruption
- acute renal failure
- hepatic hematoma
- liver rupture
- ascities
- hemorrhage
- fetal death
- maternal death
management: delivery
Eclampsia:
- what is this?
- management
What: all preeclampsia signs and sx plus seizures/coma.
if pt convulsing: supportive care
DOC for seizures: magnesium sulfate (4-6mEq/L)
- watch for signs of magnesium toxicity; loss of DTRs & decreased resp rate
- can be reversed with Calcium gluconate
- crosses the placenta
Deliver the baby!!
Post partum:
-continue magnesium sulfate until postpartum resolution
