Pre-eclampsia, Eclampsia and HELLP syndrome

Dr.Victor M De Leon Anzures Hospital O,horan UCIA Medicina Critica y Terapia Intensiva

Pre-Eclampsia
Definitiona disorder associated with pregnancy consisting of hypertension, proteinuria and new-onset dependent oedema, most commonly after 20 weeks of gestation

Eclampsia
Definitionpre eclampsia complicated with seizures

Diagnosis

Hypertension- syst > 140mmHg or 30mm above pre-preg

diastolic > 90 mmHg or 15mm above pre-preg Two abnormal measurements, on two occasions, more than 6 hours apart

Epidemiology

Freq (US) pre-eclampsia: 6-8% of pregnancies

eclampsia: 0.05-0.2%

Aetiology

Exact pathophysiology unknown Possible causes

dysfunction of the uteroplacental bed leading to vasoconstriction, platelet aggregation and hypercoagulability altered CoV reactivity, vasospasm, microthrombi, implantation problems, hypertension etc

Mortality/Morbidity

Maternal: 8-36% most frequently related to seizure activity

Foetal: 13-30% most frequently related to iatrogenic prematurity

Symptoms

Headache Oedema Visual disturbance Focal neurology, fits, anxiety, amnesia Abdo pain SOBOE Decreased urine output None

Signs

Hypertension Tachycardia and tachypnoea Creps or wheeze on auscultation Neurological deficit Hyperreflexia Petechiae, intracranial haemorrhage Generalised oedema Small uterus for dates

Risk Factors

Low socioeconomic class Multiple foetuses, or hydatid Maternal age <20 or >35yrs Primip Gestational or pre-gestational DM Renal disease Afro Caribbean- twice as likely Family history- four times the risk

Investigation

Hypertension Urinalysis- proteinuria greater than 2+ Blood tests CT head Foetal USS

Treatment

ABC, BZDs for seizures Hypertension alone- not true preeclampsia but need follow-up Hypertension and proteinuria- preeclampsia must be ruled out, d/w O&G Severe pre-eclampsia-as if eclampsia, careful BP control, Mg, delivery. O&G/ITU

Complications/prognosis

Permanent neuro damage Renal insufficiency Abruption Death 25% of eclamptics will be so in future pregnancies Increased risk of essential hypertension

HELLP syndrome

Undiagnosed pre-eclampsia progresses to causeHaemolysis Elevated Liver enzymes Low Platelets

May also occur de novo

HELLP 2

Incidence-

0.1-0.6% of pregnancies 4-12% of pre-eclampsia Similar to pre-eclampsia with

RUQ/epigastric pain Jaundice Microangiopathic anaemia Deranged LFTs

Treatment- ABC, O&G, admit, deliver