Pre-eclampsia, Eclampsia and

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

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

pre eclampsia complicated with
seizures
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
Epidemiology
Freq (US)
pre-eclampsia: 6-8% of pregnancies

eclampsia: 0.05-0.2%

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
Mortality/Morbidity
Maternal: 8-36% most frequently related
to seizure activity

Foetal: 13-30% most frequently related to
iatrogenic prematurity
Symptoms
Headache
Oedema
Visual disturbance
Focal neurology, fits, anxiety, amnesia
Abdo pain
SOBOE
Decreased urine output
None


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

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
Investigation
Hypertension
Urinalysis- proteinuria greater than 2+
Blood tests
CT head
Foetal USS
Treatment
ABC, BZDs 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
Complications/prognosis
Permanent neuro damage
Renal insufficiency
Abruption
Death
25% of eclamptics will be so in future
pregnancies
Increased risk of essential hypertension
HELLP syndrome
Undiagnosed pre-eclampsia progresses to
cause-
Haemolysis
Elevated Liver enzymes
Low Platelets

May also occur de novo
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 LFTs
Treatment- ABC, O&G, admit, deliver