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 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

Epidemiology Freq (US) pre-eclampsia: 6-8% of pregnancies

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

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

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

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

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

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

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

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

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

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