PREECLAMPSIA, ECLAMPSIA  and HELLP

 

Classification:

  1. Gestational HTN:
     
    • Pregnant pt can have established HTN before pregnancy or develop HTN during pregnancy(Gestational  HTN). These are not accompanied with edema/proteinuria.
       
  2. Preeclampsia:
     
    • Is an extension of  Gestational HTN accompanied with proteinuria >300 mg/24 hrs and generalized edema. It occurs after 20 wks of pregnancy and may persist  1 wk after delivery. In addition to above symptoms pt may c/o headache and blurry  vision. If pt also shows Hemolysis, ­LFT and Thrombocytopenia, dx of HELLP is entertained. Based on degree of SBP, DBP and proteinuria, Preeclampsia is classified into mild, moderate and severe.
       
  3. Eclampsia:
    • Is the presence of  Preeclampsia topped with coma and/or seizure.

Treatment of Preeclampsia and Eclampsia:

  1. Ranges from bed rest in case of mild preeclampsia to institution of  MgSO4 (has both antiHTN and antiSZ effects - see below) and delivery.
     
  2. MgSO4 is given 4-6 gr. IV over 20 min followed with a maintenance dose of 1-3 gr/hr. The therapeutic goal  is abolition of SZ and BP of  140/90. Side Effects are very dangerous and c/o  DTRs and  apnea. Side  Effects are reversed with CaGluconate.  Diuretics are not used unless pt develops pulmonary edema.
     
  3. If  MgSO4 not helpful in 4-6 hrs. pt is given Hydralazine 10 mg and STAT delivery.
     
  4. 4. Post partum eclampsia can present for  up to 2 wks. and treated as above.

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