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Pre-eclampsia, Eclampsia and HELLP syndrome

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

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Pre-eclampsia, Eclampsia and HELLP syndrome

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

  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”

  3. Eclampsia Definition- “ pre-eclampsia complicated with seizures”

  4. 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

  5. Epidemiology • Freq (US) pre-eclampsia: 6-8% of pregnancies eclampsia: 0.05-0.2%

  6. 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

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

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

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

  10. 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

  11. Investigation • Hypertension • Urinalysis- proteinuria greater than 2+ • Blood tests • CT head • Foetal USS

  12. Treatment • ABC, BZD’s for seizures • Hypertension alone- not true pre-eclampsia but need follow-up • 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

  13. Complications/prognosis • Permanent neuro damage • Renal insufficiency • Abruption • Death • 25% of eclamptics will be so in future pregnancies • Increased risk of essential hypertension

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

  15. 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 LFT’s • Treatment- ABC, O&G, admit, deliver

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