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”

3. EclampsiaEclampsia
Definition-Definition-
““pre eclampsia complicated withpre eclampsia complicated with
seizures”seizures”

4. DiagnosisDiagnosis
 Hypertension- syst > 140mmHgHypertension- syst > 140mmHg
or 30mm above pre-pregor 30mm above pre-preg
diastolic > 90 mmHgdiastolic > 90 mmHg
or 15mm above pre-pregor 15mm above pre-preg
Two abnormal measurements, on twoTwo abnormal measurements, on two
occasions, more than 6 hours apartoccasions, more than 6 hours apart

5. EpidemiologyEpidemiology
 Freq (US)Freq (US)
pre-eclampsia: 6-8% of pregnanciespre-eclampsia: 6-8% of pregnancies
eclampsia: 0.05-0.2%eclampsia: 0.05-0.2%

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

8. SymptomsSymptoms
 HeadacheHeadache
 OedemaOedema
 Visual disturbanceVisual disturbance
 Focal neurology, fits, anxiety, amnesiaFocal neurology, fits, anxiety, amnesia
 Abdo painAbdo pain
 SOBOESOBOE
 Decreased urine outputDecreased urine output
 NoneNone

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

11. InvestigationInvestigation
 HypertensionHypertension
 Urinalysis- proteinuria greater than 2+Urinalysis- proteinuria greater than 2+
 Blood testsBlood tests
 CT headCT head
 Foetal USSFoetal USS

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