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Pre eclampsia

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  • 1. Pre-eclampsia, Eclampsia andPre-eclampsia, Eclampsia and HELLP syndromeHELLP syndrome Dr.Victor M De Leon AnzuresDr.Victor M De Leon Anzures Hospital O,horan UCIAHospital O,horan UCIA Medicina Critica y Terapia IntensivaMedicina Critica y Terapia Intensiva
  • 2. Pre-EclampsiaPre-Eclampsia Definition-Definition- ““a disorder associated with pregnancya disorder associated with pregnancy consisting of hypertension, proteinuria andconsisting of hypertension, proteinuria and new-onset dependent oedema, mostnew-onset dependent oedema, most commonly after 20 weeks of gestation”commonly after 20 weeks of gestation”
  • 3. EclampsiaEclampsia Definition-Definition- ““pre eclampsia complicated withpre eclampsia complicated with seizures”seizures”
  • 4. DiagnosisDiagnosis  Hypertension- syst > 140mmHgHypertension- syst > 140mmHg or 30mm above pre-pregor 30mm above pre-preg diastolic > 90 mmHgdiastolic > 90 mmHg or 15mm above pre-pregor 15mm above pre-preg Two abnormal measurements, on twoTwo abnormal measurements, on two occasions, more than 6 hours apartoccasions, more than 6 hours apart
  • 5. EpidemiologyEpidemiology  Freq (US)Freq (US) pre-eclampsia: 6-8% of pregnanciespre-eclampsia: 6-8% of pregnancies eclampsia: 0.05-0.2%eclampsia: 0.05-0.2%
  • 6. AetiologyAetiology  Exact pathophysiology unknownExact pathophysiology unknown  Possible causes-Possible causes-  dysfunction of the uteroplacental bed leadingdysfunction of the uteroplacental bed leading to vasoconstriction, platelet aggregation andto vasoconstriction, platelet aggregation and hypercoagulabilityhypercoagulability  altered CoV reactivity, vasospasm,altered CoV reactivity, vasospasm, microthrombi, implantation problems,microthrombi, implantation problems, hypertension etchypertension etc
  • 7. Mortality/MorbidityMortality/Morbidity  Maternal: 8-36% most frequently related toMaternal: 8-36% most frequently related to seizure activityseizure activity  Foetal: 13-30% most frequently related toFoetal: 13-30% most frequently related to iatrogenic prematurityiatrogenic prematurity
  • 8. SymptomsSymptoms  HeadacheHeadache  OedemaOedema  Visual disturbanceVisual disturbance  Focal neurology, fits, anxiety, amnesiaFocal neurology, fits, anxiety, amnesia  Abdo painAbdo pain  SOBOESOBOE  Decreased urine outputDecreased urine output  NoneNone
  • 9. SignsSigns  HypertensionHypertension  Tachycardia and tachypnoeaTachycardia and tachypnoea  Creps or wheeze on auscultationCreps or wheeze on auscultation  Neurological deficitNeurological deficit  HyperreflexiaHyperreflexia  Petechiae, intracranial haemorrhagePetechiae, intracranial haemorrhage  Generalised oedemaGeneralised oedema  Small uterus for datesSmall uterus for dates
  • 10. Risk FactorsRisk Factors  Low socioeconomic classLow socioeconomic class  Multiple foetuses, or hydatidMultiple foetuses, or hydatid  Maternal age <20 or >35yrsMaternal age <20 or >35yrs  PrimipPrimip  Gestational or pre-gestational DMGestational or pre-gestational DM  Renal diseaseRenal disease  Afro Caribbean- twice as likelyAfro Caribbean- twice as likely  Family history- four times the riskFamily history- four times the risk
  • 11. InvestigationInvestigation  HypertensionHypertension  Urinalysis- proteinuria greater than 2+Urinalysis- proteinuria greater than 2+  Blood testsBlood tests  CT headCT head  Foetal USSFoetal USS
  • 12. TreatmentTreatment  ABC, BZD’s for seizuresABC, BZD’s for seizures  Hypertension alone- not true pre-Hypertension alone- not true pre- eclampsia but need follow-upeclampsia but need follow-up  Hypertension and proteinuria- pre-Hypertension and proteinuria- pre- eclampsia must be ruled out, d/w O&Geclampsia must be ruled out, d/w O&G  Severe pre-eclampsia-as if eclampsia,Severe pre-eclampsia-as if eclampsia, careful BP control, Mg, delivery. O&G/ITUcareful BP control, Mg, delivery. O&G/ITU
  • 13. Complications/prognosisComplications/prognosis  Permanent neuro damagePermanent neuro damage  Renal insufficiencyRenal insufficiency  AbruptionAbruption  DeathDeath  25% of eclamptics will be so in future25% of eclamptics will be so in future pregnanciespregnancies  Increased risk of essential hypertensionIncreased risk of essential hypertension
  • 14. HELLP syndromeHELLP syndrome  Undiagnosed pre-eclampsia progresses toUndiagnosed pre-eclampsia progresses to cause-cause- HHaemolysisaemolysis EElevatedlevated LLiver enzymesiver enzymes LLowow PPlateletslatelets  May also occur de novoMay also occur de novo
  • 15. HELLP 2HELLP 2  Incidence- 0.1-0.6% of pregnanciesIncidence- 0.1-0.6% of pregnancies 4-12% of pre-eclampsia4-12% of pre-eclampsia  Similar to pre-eclampsia withSimilar to pre-eclampsia with  RUQ/epigastric painRUQ/epigastric pain  JaundiceJaundice  Microangiopathic anaemiaMicroangiopathic anaemia  Deranged LFT’sDeranged LFT’s  Treatment- ABC, O&G, admit, deliverTreatment- ABC, O&G, admit, deliver