Pre-eclampsia, Eclampsia and HELLP syndrome课件.ppt

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 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, 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 OG Severe pre-eclampsia-as if eclampsia, careful BP control, Mg, delivery. OG/ITU Complications/prognosis Permanent neuro damage Renal insufficien