eclampsia untuk kuliah

7/27/2019 Eclampsia Untuk Kuliah

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Pre-eclampsia, Eclampsia and

HELLP syndrome



Pre-Eclampsia

Definition-

“a disorder associated with pregnancyconsisting of hypertension, proteinuria andnew-onset dependent oedema, most

commonly after 20 weeks of gestation”



Diagnosis

Hypertension- syst > 140mmHg

or 30mm above pre-preg

diastolic > 90 mmHg

or 15mm above pre-pregTwo abnormal measurements, on two

occasions, more than 6 hours apart



Emergencies:

Emergency hypertension

Pulmonary edema

Severe bleedings

Acute renal failure

Brain accident/seizures Hepatic ruptured



Epidemiology

Freq (US)

pre-eclampsia: 6-8% of pregnancies

eclampsia: 0.05-0.2%



Etiology

Exact pathophysiology unknown

Possible causes-

dysfunction of the uteroplacental bed leadingto vasoconstriction, platelet aggregation andhypercoagulability

altered CoV reactivity, vasospasm,microthrombi, implantation problems,hypertension etc



Mortality/Morbidity

Maternal: 8-36% most frequently relatedto seizure activity

Fetal: 13-30% most frequently related toiatrogenic prematurity



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



Symptoms

Headache

Oedema

Visual disturbance Focal neurology, fits, anxiety, amnesia

Abdo pain

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



Investigation

Hypertension

Urinalysis- proteinuria greater than 2+

Blood tests

CT head

Foetal USS



Fetal complications of severe preeclampsia

Intrauterine growthretardation

Premature delivery Abruptio placentae

Fetal distress/fetal demise

Associated maternal risks

General/regional anesthesia

DIC

Hemorrhage



Maternal complications of severepreeclampsia

Cardiovascular dysfunction (cardiac failure,hypertension)

Renal dysfunction (oliguria, reduced GFR, elevatedcreatinine, acute tubular necrosis, cortical necrosis)

Respiratory dysfunction (ARDS, pulmonary edema)

Hepatic dysfunction (elevated liver enzymes, subcapsularhematoma, HELLP syndrome)

Cerebral dysfunction (encephalopathy, ischemia, corticalblindness, retinal detachment, infarction, hemorrhage,edema, eclampsia)



Complications/prognosis

Permanent neuro damage

Renal insufficiency

Abruption

Death

25% of eclamptics will be so in futurepregnancies

Increased risk of essential hypertension



HELLP syndrome

Undiagnosed pre-eclampsia progresses tocause-

Haemolysis

Elevated Liver enzymes

Low Platelets

May also occur de novo



HELLP

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



Eclampsia

Definition-

“pre eclampsia complicated withseizures”



”Delivery of the fetus and placenta is the definitive management of severe preeclampsia. Once severe disease has been established and isprogressing, delivery of the fetus and placenta must be accomplishedto limit maternal risk.”

Int Care Med 1997: 23: 248-255

eclampsia untuk kuliah

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