2. Pregnancy related Illnesses Preeclampsia  HTN, proteinuria & edema Eclampsia  Preeclampsia + Sz HELLP  Hemolysis, elevated LFT & Low plt count TTP  low plt, MAHA, renal & CNS dysfunction

3. AFLPPE/ECHELLPTTP Liver sizesmall ALT/AST↑↑↑ Billirubin↑↑↑ Glucose↓ Ammonia↑ Hemolysis+++ Renal Failure +

4. Severe Preeclampsia New onset proteinuric HTN & at least one of the following: CNS Symptoms Symptoms of liver capsule distention Hepatocellular injury: Serum ALT & AST> 2 N Severe BP: SBP160 or DBP110 mm Hg on two occasions at least six hours apart

5. Severe Preeclampsia Thrombocytopenia:< 100,000 Proteinuria:> 5gm/24 hours Oliguria <500 mL/24h Pulmonary edema Cerebrovascular accident Severe fetal growth restriction

6. Management Lines Early diagnosis & Close observation Early delivery Corticosteroid  HELLP faster recovery & less relapse Hiemel Eur Jr Obst & Gyne 2006 BP control  hydralazine, Labetalol, Nifidipine ACEI & ARB are contraindicated

7. Management Lines Sz prevention MgSO4 superior to phenytoin ( 0 Vs 9 cases out of 2000 pt) Lucas NEJM 1995 Sz Rx MgSO4is better than phenytoin & diazepam (1500 pt)  better termination & less recurrence Collaborative Eclampsia Trial. Lancet 1995

8. Management Lines IVIG & Plasmapherisis TTP & non resolving HELLP cases (case reports no RCT ) Surgery HELLP related liver rupture