Preeclampsia Eclampsia HELLP Syndrome in Pregnancy State University

Preeclampsia, Eclampsia & HELLP Syndrome in Pregnancy State University of New York Institute of Technology Svetlana Avsyanik, RN

Objectives � To educate pregnant women on the importance of prenatal care and educate them on the complications that pertain to human pregnancy. �To be knowledgeable of signs and symptoms of preeclampsia �To be knowledgeable of eclampsia and what signs to report to physician �To be knowledgeable of what HELLP syndrome is and the consequences it can have on a patient and their baby � To educate my co-workers of signs and symptoms of preeclampsia, eclampsia and HELLP syndrome to safely manage our patients and their unborn child. �To be knowledgeable of eclamptic lab values (CBC, CMP, Uric acid, LDH, ) �To be knowledgeable of normal/abnormal urine results (proteinuria)

PICO Statement Population: Pregnant women in 3 rd trimester � Intervention: What is the best prevention treatment for high blood pressure in pregnancy- Mg. So 4 infusion therapy, IV push drugs or oral medications? � Comparison: Caucasian vs. African American females � Outcome: To decrease high blood pressure which can lean to preeclampsia, eclampsia or HELLP syndrome in pregnancy �

Preeclampsia � A multisystem disorder characterized by elevated blood pressure and proteinuria that is unique to human pregnancy. › Because the cause is largely hypertension, it is more frequently seen in African American patients, women of maternal age or obese. �The Magpie trial Collaborative Group, 2002 did an international large controlled, randomized study of 10, 110 women to evaluate the effects of Mg. So 4 on women and their babies �Conclusion: Mg. So 4 therapy halves the risk of eclampsia, and reduces risk of placental abruption by 27% and the risk of maternal death by 45%.

Eclampsia � Commonly defined as a new onset of Grand-Mal seizure activity in pregnant women that are not otherwise related to an existing brain condition. �Muscle aches and pains �Seizures �Severe agitation �Unconsciousness �Severely elevated BP’s �Eclampsia follows a pre-existing condition called preeclampsia with elevated BP’s, excess and rapid weight gain (>2 lbs/wk).

HELLP Syndrome � H - hemolysis (breaking down of red blood cells) � EL – elevated liver enzymes � LP – low platelet count › Most common reason for mothers to get ill or die are liver rupture or stroke �cerebral edema or cerebral hemorrhage

Nursing Plan/Implementation � � � � Monitor BP’s (SBP >140 and/or DBP >90) Assess reflexes Assess edema Ask about visual disturbances Monitor lab values – CBC, CMP, Uric Acid, LDH Check for proteinuria Manage medications �Mg. So 4 IV infusion �IV push drugs – Labetalol, Hydralazine �Oral medications – Niphedipine, Labetalol, Aspirin, Calcium � Assess for possible transfer to higher level of care

Key Points � Women with preeclampsia or eclampsia have higher risk of: �Preterm delivery that can lead to complications in the baby �Placental abruption of placenta from the uterus �Blood clotting problems Early diagnosis of HELLP syndrome is crucial because the morbidity/mortality rates associated with this syndrome can be as high as 25%. Most often the definitive treatment for these complications are delivery of baby and placenta. Transfusions of some form of blood product is often needed –red cells, platelets or plasma.

Conclusion � Unfortunately there is still no tool to aid the early diagnosis of pre-eclampsia; therefore pregnant women will continue to present with severe pre-eclampsia and will require quick and effective management from a collaborative team of healthcare professionals. › This disease can come on quick and if symptoms are not related to the physician, it can have devastating effects on the patient and her unborn child �Preeclampsia (PE) is a serious multisystem disorder in pregnancy and is a leading cause of maternal and fetal morbidity and mortality worldwide (Wiebke, Sarosh & Holger, 2013).

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