Pre-eclampsia, Eclampsia and HELLP syndrome

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Pre-eclampsia, Eclampsia and HELLP syndrome

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

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Pre-Eclampsia

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

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Eclampsia

• Definition-
• pre eclampsia complicated with seizures

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Diagnosis

• Hypertension- syst gt 140mmHg
• or 30mm above pre-preg
• diastolic gt 90 mmHg
• or 15mm above pre-preg
• Two abnormal measurements, on two occasions, more
  than 6 hours apart

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Epidemiology

• Freq (US)
• pre-eclampsia 6-8 of pregnancies
• eclampsia 0.05-0.2

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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

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Mortality/Morbidity

• Maternal 8-36 most frequently related to
  seizure activity
• Foetal 13-30 most frequently related to
  iatrogenic prematurity

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Symptoms

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

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Signs

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

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Risk Factors

• Low socioeconomic class
• Multiple foetuses, or hydatid
• Maternal age lt20 or gt35yrs
• Primip
• Gestational or pre-gestational DM
• Renal disease
• Afro Caribbean- twice as likely
• Family history- four times the risk

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Investigation

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

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Treatment

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

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Complications/prognosis

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

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HELLP syndrome

• Undiagnosed pre-eclampsia progresses to cause-
• Haemolysis
• Elevated Liver enzymes
• Low Platelets
• May also occur de novo

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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, OG, admit, deliver