Pre-eclampsia, Eclampsia and HELLP syndrome Dr.Victor M De Leon Anzures Hospital O,horan UCIA...
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Pre-eclampsia, Pre-eclampsia, Eclampsia and HELLP Eclampsia and HELLP syndrome syndrome Dr.Victor M De Leon Anzures Dr.Victor M De Leon Anzures Hospital O,horan UCIA Hospital O,horan UCIA Medicina Critica y Terapia Medicina Critica y Terapia Intensiva Intensiva
Pre-eclampsia, Eclampsia and HELLP syndrome Dr.Victor M De Leon Anzures Hospital O,horan UCIA Medicina Critica y Terapia Intensiva
Pre-eclampsia, Eclampsia and HELLP syndrome Dr.Victor M De Leon
Anzures Hospital O,horan UCIA Medicina Critica y Terapia
Intensiva
Slide 2
Pre-Eclampsia Definition- a disorder associated with pregnancy
consisting of hypertension, proteinuria and new-onset dependent
oedema, most commonly after 20 weeks of gestation a disorder
associated with pregnancy consisting of hypertension, proteinuria
and new-onset dependent oedema, most commonly after 20 weeks of
gestation
Slide 3
Eclampsia Definition- pre eclampsia complicated with
seizures
Slide 4
Diagnosis Hypertension- syst > 140mmHg 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
Aetiology Exact pathophysiology unknown Exact pathophysiology
unknown Possible causes- Possible causes- dysfunction of the
uteroplacental bed leading to vasoconstriction, platelet
aggregation and hypercoagulability dysfunction of the
uteroplacental bed leading to vasoconstriction, platelet
aggregation and hypercoagulability altered CoV reactivity,
vasospasm, microthrombi, implantation problems, hypertension etc
altered CoV reactivity, vasospasm, microthrombi, implantation
problems, hypertension etc
Slide 7
Mortality/Morbidity Maternal: 8-36% most frequently related to
seizure activity Maternal: 8-36% most frequently related to seizure
activity Foetal: 13-30% most frequently related to iatrogenic
prematurity Foetal: 13-30% most frequently related to iatrogenic
prematurity
Signs Hypertension Hypertension Tachycardia and tachypnoea
Tachycardia and tachypnoea Creps or wheeze on auscultation Creps or
wheeze on auscultation Neurological deficit Neurological deficit
Hyperreflexia Hyperreflexia Petechiae, intracranial haemorrhage
Petechiae, intracranial haemorrhage Generalised oedema Generalised
oedema Small uterus for dates Small uterus for dates
Slide 10
Risk Factors Low socioeconomic class Low socioeconomic class
Multiple foetuses, or hydatid Multiple foetuses, or hydatid
Maternal age 35yrs Maternal age 35yrs Primip Primip Gestational or
pre-gestational DM Gestational or pre-gestational DM Renal disease
Renal disease Afro Caribbean- twice as likely Afro Caribbean- twice
as likely Family history- four times the risk Family history- four
times the risk
Slide 11
Investigation Hypertension Hypertension Urinalysis- proteinuria
greater than 2+ Urinalysis- proteinuria greater than 2+ Blood tests
Blood tests CT head CT head Foetal USS Foetal USS
Slide 12
Treatment ABC, BZDs for seizures ABC, BZDs for seizures
Hypertension alone- not true pre- eclampsia but need follow-up
Hypertension alone- not true pre- eclampsia but need follow-up
Hypertension and proteinuria- pre- eclampsia must be ruled out, d/w
O&G Hypertension and proteinuria- pre- eclampsia must be ruled
out, d/w O&G Severe pre-eclampsia-as if eclampsia, careful BP
control, Mg, delivery. O&G/ITU Severe pre-eclampsia-as if
eclampsia, careful BP control, Mg, delivery. O&G/ITU
Slide 13
Complications/prognosis Permanent neuro damage Permanent neuro
damage Renal insufficiency Renal insufficiency Abruption Abruption
Death Death 25% of eclamptics will be so in future pregnancies 25%
of eclamptics will be so in future pregnancies Increased risk of
essential hypertension Increased risk of essential
hypertension
Slide 14
HELLP syndrome Undiagnosed pre-eclampsia progresses to cause-
Undiagnosed pre-eclampsia progresses to cause- Haemolysis Elevated
Liver enzymes Low Platelets May also occur de novo May also occur
de novo
Slide 15
HELLP 2 Incidence- 0.1-0.6% of pregnancies Incidence- 0.1-0.6%
of pregnancies 4-12% of pre-eclampsia Similar to pre-eclampsia with
Similar to pre-eclampsia with RUQ/epigastric pain RUQ/epigastric
pain Jaundice Jaundice Microangiopathic anaemia Microangiopathic
anaemia Deranged LFTs Deranged LFTs Treatment- ABC, O&G, admit,
deliver Treatment- ABC, O&G, admit, deliver