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”

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

4. Diagnosis 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) pre-eclampsia: 6-8% of pregnancies

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

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

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

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

10. Risk Factors Low socioeconomic class Multiple foetuses, or hydatid
Maternal age <20 or >35yrs
Primip
Gestational or pre-gestational DM
Renal disease
Afro Caribbean- twice as likely
Family history- four times the risk

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

12. Treatment ABC, BZD’s for seizures
Hypertension alone- not true pre-eclampsia but need follow-up
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

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

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

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