questions 3

Preeclampsia / Eclampsia / HELLP Syndrome

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Topic updated on 11/20/16 1:03pm

Introduction
  • Preeclampsia
    • hypertension, proteinuria, and edema
  • Eclampsia
    • preeclampsia + seizures
  • HELLP syndrome
    • form of preeclampsia with
      • Hemolysis, Elevated LFTs, Low Platelets
  • Risk factors
    • preexisting hypertension
    • maternal age of < 20 years and > 35 years
    • diabetes
    • chronic renal disease
    • autoimmune disorders
  • Typically occurs from 20 weeks gestation to 6 weeks postpartum
    • if symptoms occur before 20 weeks think molar pregnancy
  • Pathophysiology
    • placental ischemia secondary to impaired vasodilation of spiral arteries
    • results in ↑ vascular tone
      • ↑ vasoconstrictors
      • ↓ vasodilators
    • ↑ VEGF
Presentation
  • Symptoms
    • headache
    • blurred vision
    • abdominal pain
    • weight gain (water retention)
  • Physical exam
    • edema of face and extremities
    • altered mentation
    • hyperreflexia
Evaluation
  • Serology
    • thrombocytopenia
    • hyperuricemia
Treatment
  • Delivery
    • as soon as fetus is viable
  • Bed rest
  • Salt restriction
  • Monitoring and treatment of hypertension
  • IV magnesium sulfate and diazepam
    • prevention/treatment of seizures in eclampsia
Prognosis, Prevention, and Complications
  • Complications
    • maternal cerebral hemorrhage and ARDS


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(M1.RP.2) A 36-year-old primigravida woman visits her gynecologist during the 28th week of her pregnancy. Physical examination reveals pitting edema around her ankles and elevated systolic blood pressure. 24-hour urine collection yields 4 grams of protein. If left untreated, the patient is at increased risk for which of the following: Topic Review Topic

1. Urethral infection
2. Hypovolemic shock
3. Hemolysis
4. Gestational diabetes
5. Placenta accreta

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