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Pre eclampsia
1. Pre-eclampsia, Eclampsia andPre-eclampsia, Eclampsia and
HELLP syndromeHELLP syndrome
Dr.Victor M De Leon AnzuresDr.Victor M De Leon Anzures
Hospital O,horan UCIAHospital O,horan UCIA
Medicina Critica y Terapia IntensivaMedicina Critica y Terapia Intensiva
2. Pre-EclampsiaPre-Eclampsia
Definition-Definition-
““a disorder associated with pregnancya disorder associated with pregnancy
consisting of hypertension, proteinuria andconsisting of hypertension, proteinuria and
new-onset dependent oedema, mostnew-onset dependent oedema, most
commonly after 20 weeks of gestation”commonly after 20 weeks of gestation”
6. AetiologyAetiology
Exact pathophysiology unknownExact pathophysiology unknown
Possible causes-Possible causes-
dysfunction of the uteroplacental bed leadingdysfunction of the uteroplacental bed leading
to vasoconstriction, platelet aggregation andto vasoconstriction, platelet aggregation and
hypercoagulabilityhypercoagulability
altered CoV reactivity, vasospasm,altered CoV reactivity, vasospasm,
microthrombi, implantation problems,microthrombi, implantation problems,
hypertension etchypertension etc
7. Mortality/MorbidityMortality/Morbidity
Maternal: 8-36% most frequently related toMaternal: 8-36% most frequently related to
seizure activityseizure activity
Foetal: 13-30% most frequently related toFoetal: 13-30% most frequently related to
iatrogenic prematurityiatrogenic prematurity
9. SignsSigns
HypertensionHypertension
Tachycardia and tachypnoeaTachycardia and tachypnoea
Creps or wheeze on auscultationCreps or wheeze on auscultation
Neurological deficitNeurological deficit
HyperreflexiaHyperreflexia
Petechiae, intracranial haemorrhagePetechiae, intracranial haemorrhage
Generalised oedemaGeneralised oedema
Small uterus for datesSmall uterus for dates
10. Risk FactorsRisk Factors
Low socioeconomic classLow socioeconomic class
Multiple foetuses, or hydatidMultiple foetuses, or hydatid
Maternal age <20 or >35yrsMaternal age <20 or >35yrs
PrimipPrimip
Gestational or pre-gestational DMGestational or pre-gestational DM
Renal diseaseRenal disease
Afro Caribbean- twice as likelyAfro Caribbean- twice as likely
Family history- four times the riskFamily history- four times the risk
12. TreatmentTreatment
ABC, BZD’s for seizuresABC, BZD’s for seizures
Hypertension alone- not true pre-Hypertension alone- not true pre-
eclampsia but need follow-upeclampsia but need follow-up
Hypertension and proteinuria- pre-Hypertension and proteinuria- pre-
eclampsia must be ruled out, d/w O&Geclampsia must be ruled out, d/w O&G
Severe pre-eclampsia-as if eclampsia,Severe pre-eclampsia-as if eclampsia,
careful BP control, Mg, delivery. O&G/ITUcareful BP control, Mg, delivery. O&G/ITU
13. Complications/prognosisComplications/prognosis
Permanent neuro damagePermanent neuro damage
Renal insufficiencyRenal insufficiency
AbruptionAbruption
DeathDeath
25% of eclamptics will be so in future25% of eclamptics will be so in future
pregnanciespregnancies
Increased risk of essential hypertensionIncreased risk of essential hypertension
14. HELLP syndromeHELLP syndrome
Undiagnosed pre-eclampsia progresses toUndiagnosed pre-eclampsia progresses to
cause-cause-
HHaemolysisaemolysis
EElevatedlevated LLiver enzymesiver enzymes
LLowow PPlateletslatelets
May also occur de novoMay also occur de novo
15. HELLP 2HELLP 2
Incidence- 0.1-0.6% of pregnanciesIncidence- 0.1-0.6% of pregnancies
4-12% of pre-eclampsia4-12% of pre-eclampsia
Similar to pre-eclampsia withSimilar to pre-eclampsia with
RUQ/epigastric painRUQ/epigastric pain
JaundiceJaundice
Microangiopathic anaemiaMicroangiopathic anaemia
Deranged LFT’sDeranged LFT’s
Treatment- ABC, O&G, admit, deliverTreatment- ABC, O&G, admit, deliver