1. Pre-eclampsia, Eclampsia and HELLP syndrome Dr.Victor M De Leon Anzures Hospital O,horan UCIA Medicina Critica y Terapia Intensiva

2. Pre-Eclampsia Definition- “a disorder associated with pregnancy consisting of hypertension, proteinuria and new-onset dependent oedema, most commonly after 20 weeks of gestation” “a disorder associated with pregnancy consisting of hypertension, proteinuria and new-onset dependent oedema, most commonly after 20 weeks of gestation”

3. Eclampsia Definition- “pre eclampsia complicated with seizures”

4. Diagnosis Hypertension- syst > 140mmHg Hypertension- syst > 140mmHg or 30mm above pre-preg diastolic > 90 mmHg or 15mm above pre-preg Two abnormal measurements, on two occasions, more than 6 hours apart

5. Epidemiology Freq (US) Freq (US) pre-eclampsia: 6-8% of pregnancies eclampsia: 0.05-0.2%

6. Aetiology Exact pathophysiology unknown Exact pathophysiology unknown Possible causes- Possible causes- dysfunction of the uteroplacental bed leading to vasoconstriction, platelet aggregation and hypercoagulability dysfunction of the uteroplacental bed leading to vasoconstriction, platelet aggregation and hypercoagulability altered CoV reactivity, vasospasm, microthrombi, implantation problems, hypertension etc altered CoV reactivity, vasospasm, microthrombi, implantation problems, hypertension etc

7. Mortality/Morbidity Maternal: 8-36% most frequently related to seizure activity Maternal: 8-36% most frequently related to seizure activity Foetal: 13-30% most frequently related to iatrogenic prematurity Foetal: 13-30% most frequently related to iatrogenic prematurity

8. Symptoms Headache Headache Oedema Oedema Visual disturbance Visual disturbance Focal neurology, fits, anxiety, amnesia Focal neurology, fits, anxiety, amnesia Abdo pain Abdo pain SOBOE SOBOE Decreased urine output Decreased urine output None None

9. Signs Hypertension Hypertension Tachycardia and tachypnoea Tachycardia and tachypnoea Creps or wheeze on auscultation Creps or wheeze on auscultation Neurological deficit Neurological deficit Hyperreflexia Hyperreflexia Petechiae, intracranial haemorrhage Petechiae, intracranial haemorrhage Generalised oedema Generalised oedema Small uterus for dates Small uterus for dates

10. Risk Factors Low socioeconomic class Low socioeconomic class Multiple foetuses, or hydatid Multiple foetuses, or hydatid Maternal age 35yrs Maternal age 35yrs Primip Primip Gestational or pre-gestational DM Gestational or pre-gestational DM Renal disease Renal disease Afro Caribbean- twice as likely Afro Caribbean- twice as likely Family history- four times the risk Family history- four times the risk

11. Investigation Hypertension Hypertension Urinalysis- proteinuria greater than 2+ Urinalysis- proteinuria greater than 2+ Blood tests Blood tests CT head CT head Foetal USS Foetal USS

12. Treatment ABC, BZD’s for seizures ABC, BZD’s for seizures Hypertension alone- not true pre- eclampsia but need follow-up Hypertension alone- not true pre- eclampsia but need follow-up Hypertension and proteinuria- pre- eclampsia must be ruled out, d/w O&G Hypertension and proteinuria- pre- eclampsia must be ruled out, d/w O&G Severe pre-eclampsia-as if eclampsia, careful BP control, Mg, delivery. O&G/ITU Severe pre-eclampsia-as if eclampsia, careful BP control, Mg, delivery. O&G/ITU

13. Complications/prognosis Permanent neuro damage Permanent neuro damage Renal insufficiency Renal insufficiency Abruption Abruption Death Death 25% of eclamptics will be so in future pregnancies 25% of eclamptics will be so in future pregnancies Increased risk of essential hypertension Increased risk of essential hypertension

14. HELLP syndrome Undiagnosed pre-eclampsia progresses to cause- Undiagnosed pre-eclampsia progresses to cause- Haemolysis Elevated Liver enzymes Low Platelets May also occur de novo May also occur de novo

15. HELLP 2 Incidence- 0.1-0.6% of pregnancies Incidence- 0.1-0.6% of pregnancies 4-12% of pre-eclampsia Similar to pre-eclampsia with Similar to pre-eclampsia with RUQ/epigastric pain RUQ/epigastric pain Jaundice Jaundice Microangiopathic anaemia Microangiopathic anaemia Deranged LFT’s Deranged LFT’s Treatment- ABC, O&G, admit, deliver Treatment- ABC, O&G, admit, deliver