Pre-eclampsia, Eclampsia, & HELLP Syndrome

Question 1

Pre-eclampsia

Answer 1

New onset HTN & proteinuria or end organ dysfunction after 20 weeks gestation in a previously normotensive patient

Question 2

Eclampsia

Answer 2

Pre-eclampsia has progressed & patient now has seizures or coma

Question 3

HELLP Syndrome

Answer 3

Hemolysis
Elevated liver enzymes
Low platelets

Question 4

Pathogenesis of Pre-eclampsia, Eclampsia, HELLP Syndrome

Answer 4

Endothelial dysfunction*
HTN
Activation of platelets
CNS changes
Edema
Renal dysfunction resulting in proteinuria
Hemolysis
Hepatic ischemia

Question 5

Causes of Endothelial Dysfunction

Answer 5

Under perfusion of the placenta
Immunologic factors
Increased sensitivity to angiotensin II
Genetic Inflammation

Question 6

Endothelial Dysfunction May Lead To

Answer 6

Maternal death
Placental abruption
Acute kidney injury
Cerebral hemorrhage
Hepatic failure or rupture
Pulmonary edema
DIC
Eclampsia (seizures)

Question 7

Essentials of Diagnosis of Pre-eclampsia-Eclampsia

Answer 7

HTN

Proteinuria

Question 8

Pre-eclampsia Criteria if HTN but no Proteinuria

Answer 8

Low platelets (

Question 9

Who is most frequently affected by pre-eclampsia-eclampsia?

Answer 9

Women with their first pregnancy

Question 10

Risk Factors of Pre-Eclampsia/Eclampsia

Answer 10

Extremes of maternal age (35)

Multiples

Question 11

Pre-Eclampsia & Eclampsia Associated With

Answer 11

Chronic HTN
DM
Renal disease
Collagen disorders
Vascular disorders
Autoimmune disorders
Hydatidiform mole
New paternity
Previous pre-eclampsia or eclampia
Family history

Question 12

Cause of Pre-Eclampsia/Eclampsia

Answer 12

Imblance in placental prostacyclin & thromboxane production

Question 13

Function of Prostacyclin

Answer 13

Potent vasodilator & inhibitor of platelet aggregation

Question 14

Function of Thromboxane

Answer 14

Potent vasoconstrictor & stimulates platelet aggregation

Question 15

Normal Pregnancy Prostacycline & Thromboxane Levels

Answer 15

Prostacyclin levels = thromboxane levels

Question 16

Pre-Eclampsia Prostacyclin & Thromboxane Levels

Answer 16

Placenta produces 7x more thromboxane than prostaglandin

Question 17

Result of 7x more Thromboxane levels that Prostaglandin Levels

Answer 17

Vasoconstriction
Platelet aggregation
Reduced uteroplacental blood flow

Question 18

Delivery of Pre-Eclampsia/Eclampsia

Answer 18

Allow pregnancy to progress as far as possible

Lung development of the fetus

Question 19

Critical Factors of Delivery in Pre-Eclampsia/Eclampsia

Answer 19

Gestational age of fetus
Maturity of fetal lungs
Severity of maternal disease

Question 20

Treatment of Pre-Eclampsia at 36 Weeks

Answer 20

Delivery

Question 21

Treatment of Pre-Eclampsia Prior to 36 weeks

Answer 21

Severe: delivery

Question 22

What Signs/Symptoms are Strong Indicators for Delivery with Pre-Eclampsia/Eclampsia

Answer 22

Epigastric pain
Thrombocytopenia
Visual disturbances

Question 23

Management of Mild Pre-Eclampsia

Answer 23

Best rest
Low dose ASA
Antihypertensive therapy

Question 24

ASA in High Risk Groups of Pre-Eclampsia

Answer 24

Chronic HTN
Hx of placental abruption
PIH in previous pregnancy
Systemic lupus

Question 25

Antihypertensive Therapy in the Management of Mild Pre-Eclampsia

Answer 25

Hydralazine | Methyldopa

Question 26

Management of Moderate to Severe Pre-Eclampsia

Answer 26

Hospitalization Far enough along: delivery baby Not far enough along: place on magnesium sulfate drip to prevent seizures

Question 27

Regular Assessment of Pre-Eclampsia

Answer 27

``` BP Reflexes Urine protein FHT & activity CBC Platelet count Electrolytes Liver enzymes 24 urine collection for CrCl & protein Fetal evaluation Daily fetal kick counts Consider amniocentesis ```

Question 28

Steroids for Mom to Help with Fetal Lung Development

Answer 28

Betamethasone (Diprolene) | Dexamethasone (Decadron)

Question 29

Severe Pre-Eclampsia

Answer 29

BP: 160+/110+ Proteinuria: >500 mg/day Oliguria:

Question 30

Systemic Associations with Severe Pre-Eclampsia

Answer 30

Renal insufficiency Placenta abruption Pulmonary edema & pulmonary HTN due to decreased cardiac output CNS: petechial hemorrhages

Question 31

HELLP Syndrome

Answer 31

Hemolysis Elevated Liver enzymes Low Platelets

Question 32

Signs/Symptoms of HELPP Syndrome

Answer 32

``` BP mildly elevated Proteinuria +/- Edema Malaise Epigastric pain Nausea with/without vomiting RUQ tenderness ```

Question 33

HELLP Diagnosis

Answer 33

Hemolysis: peripheral smear (schistocytes, burr cells) Elevated Liver enzymes: SGOT >70 U/L, LDH >600 U/L Low Platelets:

Question 34

HELLP Complications

Answer 34

``` Placental abruption Acute renal failure Hepatic hematoma Liver rupture Ascites Hemorrhage Fetal death Maternal death ```

Question 35

Management of HELLP

Answer 35

Delivery

Question 36

Difference Between Pre-Eclampsia & Eclampsia

Answer 36

Seizure activity

Question 37

Eclampsia Emergency Care

Answer 37

Supportive if convulsing | Magnesium sulfate: control seizure activity

Question 38

Magnesium Sulfate

Answer 38

``` Given as bolus with continuous IV infusion Blood levels checked every 4-6 hours Urine output checked hourly Watch for signs of toxicity Readily crosses placenta ```

Question 39

Signs of Magnesium Sulfate Toxicity

Answer 39

Loss of DTRs | Decrease in RR & depth

Question 40

Reversal Agent for Magnesium Sulfate Toxicity

Answer 40

Calcium Gluconate

Question 41

Treatment of Eclampsia

Answer 41

Delivery | Continue Magnesium sulfate until postpartum resolution (diuresis most reliable indicator)

Question 42

After Pre-Eclampsia/Eclampsia

Answer 42

Most women return to normotensive state Increased risk with multiple pregnancies Some women develop chronic, manageable HTN