Flashcards in Pre-eclampsia, Eclampsia, and HELLP Syndrome Deck (21):
What is dx for pre-eclampsia?
- BP >/= 140/90 after 20w GA x2, at least 4h apart
- AND! proteinuria
- OR! thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, cerebral/visual changes
What is dx for severe pre-eclampsia?
BP >/= 160/110
What is dx for eclampsia?
inclusive of pre-eclampsia dx PLUS new onset seizures
What is HELLP?
Elevated Liver enzymes
severe form of pre-eclampsia
can present w/ or w/out HTN or proteinuria
What is included in the physical assessment of pts w/ PEC?
- q1h BP
- lung sounds, pulse ox, work of breathing = pulmonary edema
- epigastric pain
- visual changes
- dorsiflex foot to check for + clonus: rapid involuntary rhythmic muscle contractions
- I/Os (O at least > 30mL/h)
- deep tendon reflexes
Describe scoring of deep tendon reflexes and what is indicated
0 = absent --> mag toxicity
1+ = diminished --> mag toxicity
2+ = normal
3+ = brisk --> +/- seizure
4+ = hyperactive --> +/- seizure
What lab work is included in PEC workup?
1) creatinine (>1.1 = renal insufficiency)
- platelets < 100K = thrombocytopenia
- increased H/H
- liver enzymes elevated to 2x normal value
- AST: 3rd tri = 4-32; term = 5-103
- ALT: 3rd tri = 2-32; term = 5-115
4) protein:creatinine or 24h urine collection
What is dx of proteinuria?
- at least 300mg protine in 24h urine collection
- protein:creatine >/= 0.3
- urine dipstick protein 1+
magnesium sulfate (prevention)
4-6g IV loading dose, then 1-2g/h infusion
- if creatinine elevated, 1g/h
- keep serum levels at 4-7 mEq/L
- check for mag toxicity (DTRs, respiratory status)
antidote to mag toxicity
1g IV over 3min
5-10mg IV over 2min q20min
- max dose 20mg in first h
- contraindication: tachycardia
labetalol (Normodyne, Trandate)
20mg IV over 2min
- no effect in 10 min --> 40mg IV
- no effect in another 10 min --> 80mg IV
- max dose - 300mg in first h
- contraindications: asthma, CHF
10-20mg PO q30min
- max dose 50mg in first h
- contraindications: tachycardia
Describe emergency management of a pt having an eclamptic seizure
- put up padded side rails
- place pt in lateral decubitus position
- suction ready if vomit
Airway: 8-10L via face mask
Blood pressure: hydralazine, labetalol, or nifedipine to maintain under 160/110
Convulsions: give mag sulfate
Delivery: do not rush for c/s! Monitor for placental abruption
magnesium sulfate (tx)
treatment of active seizure
6g IV loading dose --> 2-3g/h infusion
give 2g IV bolus if seizure persists/recurs
What can be given if mag sulfate does not treat an active eclamptic seizure?
lorazepam (Ativan) 1-2mg IV
What labs indicate hemolysis in HELLP?
at least two of following:
- abnormal peripheral smear
- bilirubin > 1.2mg/dL
- haptoglobin = 1.2mg/dL
What labs indicate elevated liver enzymes in HELLP?
- AST/ALT >2x normal (>70 IU/L)
- lactate dehydrogenase > 2x normal (>600 IU/L)
What labs indicate low platelets in HELLP?
platelets < 100,000/mm3
nonspecific; similar to PEC
- RUQ/epigastric pain
- +/- HTN or proteinuria