Pre-eclampsia, Eclampsia, & HELLP Syndrome Flashcards Preview

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Flashcards in Pre-eclampsia, Eclampsia, & HELLP Syndrome Deck (42)
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1

Pre-eclampsia

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

2

Eclampsia

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

3

HELLP Syndrome

Hemolysis
Elevated liver enzymes
Low platelets

4

Pathogenesis of Pre-eclampsia, Eclampsia, HELLP Syndrome

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

5

Causes of Endothelial Dysfunction

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

6

Endothelial Dysfunction May Lead To

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

7

Essentials of Diagnosis of Pre-eclampsia-Eclampsia

HTN
Proteinuria

8

Pre-eclampsia Criteria if HTN but no Proteinuria

Low platelets (

9

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

Women with their first pregnancy

10

Risk Factors of Pre-Eclampsia/Eclampsia

Extremes of maternal age (35)
Multiples

11

Pre-Eclampsia & Eclampsia Associated With

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

12

Cause of Pre-Eclampsia/Eclampsia

Imblance in placental prostacyclin & thromboxane production

13

Function of Prostacyclin

Potent vasodilator & inhibitor of platelet aggregation

14

Function of Thromboxane

Potent vasoconstrictor & stimulates platelet aggregation

15

Normal Pregnancy Prostacycline & Thromboxane Levels

Prostacyclin levels = thromboxane levels

16

Pre-Eclampsia Prostacyclin & Thromboxane Levels

Placenta produces 7x more thromboxane than prostaglandin

17

Result of 7x more Thromboxane levels that Prostaglandin Levels

Vasoconstriction
Platelet aggregation
Reduced uteroplacental blood flow

18

Delivery of Pre-Eclampsia/Eclampsia

Allow pregnancy to progress as far as possible
Lung development of the fetus

19

Critical Factors of Delivery in Pre-Eclampsia/Eclampsia

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

20

Treatment of Pre-Eclampsia at 36 Weeks

Delivery

21

Treatment of Pre-Eclampsia Prior to 36 weeks

Severe: delivery

22

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

Epigastric pain
Thrombocytopenia
Visual disturbances

23

Management of Mild Pre-Eclampsia

Best rest
Low dose ASA
Antihypertensive therapy

24

ASA in High Risk Groups of Pre-Eclampsia

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

25

Antihypertensive Therapy in the Management of Mild Pre-Eclampsia

Hydralazine
Methyldopa

26

Management of Moderate to Severe Pre-Eclampsia

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

27

Regular Assessment of Pre-Eclampsia

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

28

Steroids for Mom to Help with Fetal Lung Development

Betamethasone (Diprolene)
Dexamethasone (Decadron)

29

Severe Pre-Eclampsia

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

30

Systemic Associations with Severe Pre-Eclampsia

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