Preeclampsia Eclampsia and HELLP syndrome Dr Victor M

Pre-eclampsia, Eclampsia and HELLP syndrome Dr. Victor M De Leon Anzures Hospital O, horan UCIA Medicina Critica y Terapia Intensiva

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

Eclampsia Definition“pre eclampsia complicated with seizures”

Diagnosis n Hypertension- syst > 140 mm. Hg or 30 mm above pre-preg diastolic > 90 mm. Hg or 15 mm above pre-preg Two abnormal measurements, on two occasions, more than 6 hours apart

Epidemiology n Freq (US) pre-eclampsia: 6 -8% of pregnancies eclampsia: 0. 05 -0. 2%

Aetiology n n Exact pathophysiology unknown Possible causesdysfunction of the uteroplacental bed leading to vasoconstriction, platelet aggregation and hypercoagulability n altered Co. V reactivity, vasospasm, microthrombi, implantation problems, hypertension etc n

Mortality/Morbidity n n Maternal: 8 -36% most frequently related to seizure activity Foetal: 13 -30% most frequently related to iatrogenic prematurity

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

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

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

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

Treatment n n ABC, BZD’s 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 n n n Permanent neuro damage Renal insufficiency Abruption Death 25% of eclamptics will be so in future pregnancies Increased risk of essential hypertension

HELLP syndrome n n Undiagnosed pre-eclampsia progresses to cause. Haemolysis Elevated Liver enzymes Low Platelets May also occur de novo

HELLP 2 n n Incidence- 0. 1 -0. 6% of pregnancies 4 -12% of pre-eclampsia Similar to pre-eclampsia with RUQ/epigastric pain n Jaundice n Microangiopathic anaemia n Deranged LFT’s n n Treatment- ABC, O&G, admit, deliver