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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Qbank (2 Questions)

TAG
(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

PREFERRED RESPONSE ▶
TAG
(M1.RP.4753) A 19-year-old primigravid woman at 33 weeks gestation arrives at her obstetrician's office. She complains she is feeling very tired and is sick of being pregnant. She notes that the swelling in her feet has been much worse recently. She has been having headaches and feels that her vision has been blurry today. Her blood pressure is 170/110 mmHg. Further testing is done showing serum aspartate aminotransferase of 52 U/L, serum alanine aminotransferase of 63 U/L, and 1+ protein on urine dipstick. Her peripheral blood smear is shown in Figure A. What is the most likely diagnosis for this patient? Topic Review Topic
FIGURES: A          

1. Eclampsia.
2. HELLP Syndrome.
3. Gestational Hypertension
4. Hepatorenal syndrome.
5. Normal pregnancy.

PREFERRED RESPONSE ▶
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