Pre eclampsia

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Pre eclampsia

  1. 1. Pre-eclampsia, Eclampsia and HELLP syndrome Dr.Victor M De Leon Anzures Hospital O,horan UCIA Medicina Critica y Terapia Intensiva
  2. 2. Pre-Eclampsia <ul><li>Definition- </li></ul><ul><li>“ a disorder associated with pregnancy consisting of hypertension, proteinuria and new-onset dependent oedema, most commonly after 20 weeks of gestation” </li></ul>
  3. 3. Eclampsia <ul><li>Definition- </li></ul><ul><li>“ pre eclampsia complicated with seizures” </li></ul>
  4. 4. Diagnosis <ul><li>Hypertension- syst > 140mmHg </li></ul><ul><li>or 30mm above pre-preg </li></ul><ul><li>diastolic > 90 mmHg </li></ul><ul><li>or 15mm above pre-preg </li></ul><ul><li>Two abnormal measurements, on two occasions, more than 6 hours apart </li></ul>
  5. 5. Epidemiology <ul><li>Freq (US) </li></ul><ul><li>pre-eclampsia: 6-8% of pregnancies </li></ul><ul><li>eclampsia: 0.05-0.2% </li></ul>
  6. 6. Aetiology <ul><li>Exact pathophysiology unknown </li></ul><ul><li>Possible causes- </li></ul><ul><ul><li>dysfunction of the uteroplacental bed leading to vasoconstriction, platelet aggregation and hypercoagulability </li></ul></ul><ul><ul><li>altered CoV reactivity, vasospasm, microthrombi, implantation problems, hypertension etc </li></ul></ul>
  7. 7. Mortality/Morbidity <ul><li>Maternal: 8-36% most frequently related to seizure activity </li></ul><ul><li>Foetal: 13-30% most frequently related to iatrogenic prematurity </li></ul>
  8. 8. Symptoms <ul><li>Headache </li></ul><ul><li>Oedema </li></ul><ul><li>Visual disturbance </li></ul><ul><li>Focal neurology, fits, anxiety, amnesia </li></ul><ul><li>Abdo pain </li></ul><ul><li>SOBOE </li></ul><ul><li>Decreased urine output </li></ul><ul><li>None </li></ul>
  9. 9. Signs <ul><li>Hypertension </li></ul><ul><li>Tachycardia and tachypnoea </li></ul><ul><li>Creps or wheeze on auscultation </li></ul><ul><li>Neurological deficit </li></ul><ul><li>Hyperreflexia </li></ul><ul><li>Petechiae, intracranial haemorrhage </li></ul><ul><li>Generalised oedema </li></ul><ul><li>Small uterus for dates </li></ul>
  10. 10. Risk Factors <ul><li>Low socioeconomic class </li></ul><ul><li>Multiple foetuses, or hydatid </li></ul><ul><li>Maternal age <20 or >35yrs </li></ul><ul><li>Primip </li></ul><ul><li>Gestational or pre-gestational DM </li></ul><ul><li>Renal disease </li></ul><ul><li>Afro Caribbean- twice as likely </li></ul><ul><li>Family history- four times the risk </li></ul>
  11. 11. Investigation <ul><li>Hypertension </li></ul><ul><li>Urinalysis- proteinuria greater than 2+ </li></ul><ul><li>Blood tests </li></ul><ul><li>CT head </li></ul><ul><li>Foetal USS </li></ul>
  12. 12. Treatment <ul><li>ABC, BZD’s for seizures </li></ul><ul><li>Hypertension alone- not true pre-eclampsia but need follow-up </li></ul><ul><li>Hypertension and proteinuria- pre-eclampsia must be ruled out, d/w O&G </li></ul><ul><li>Severe pre-eclampsia-as if eclampsia, careful BP control, Mg, delivery. O&G/ITU </li></ul>
  13. 13. Complications/prognosis <ul><li>Permanent neuro damage </li></ul><ul><li>Renal insufficiency </li></ul><ul><li>Abruption </li></ul><ul><li>Death </li></ul><ul><li>25% of eclamptics will be so in future pregnancies </li></ul><ul><li>Increased risk of essential hypertension </li></ul>
  14. 14. HELLP syndrome <ul><li>Undiagnosed pre-eclampsia progresses to cause- </li></ul><ul><li>H aemolysis </li></ul><ul><li>E levated L iver enzymes </li></ul><ul><li>L ow P latelets </li></ul><ul><li>May also occur de novo </li></ul>
  15. 15. HELLP 2 <ul><li>Incidence- 0.1-0.6% of pregnancies </li></ul><ul><li>4-12% of pre-eclampsia </li></ul><ul><li>Similar to pre-eclampsia with </li></ul><ul><ul><li>RUQ/epigastric pain </li></ul></ul><ul><ul><li>Jaundice </li></ul></ul><ul><ul><li>Microangiopathic anaemia </li></ul></ul><ul><ul><li>Deranged LFT’s </li></ul></ul><ul><li>Treatment- ABC, O&G, admit, deliver </li></ul>

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