Preeclampsia, Eclampsia & HELLP Syndrome in Pregnancy

State University of New York Institute of Technology

Svetlana Avsyanik, RN

Objectives

To educate pregnant women on the importance of prenatal care and educate them on the complications that pertain to human pregnancy.

To be knowledgeable of signs and symptoms of preeclampsia To be knowledgeable of eclampsia and what signs to report to

physician To be knowledgeable of what HELLP syndrome is and the

consequences it can have on a patient and their baby To educate my co-workers of signs and symptoms of

preeclampsia, eclampsia and HELLP syndrome to safely manage our patients and their unborn child.

To be knowledgeable of eclamptic lab values (CBC, CMP, Uric acid, LDH,)

To be knowledgeable of normal/abnormal urine results (proteinuria)

PICO Statement

Population: Pregnant women in 3rd trimester

Intervention: What is the best prevention treatment for high blood pressure in pregnancy- MgSo4 infusion therapy, IV push drugs or oral medications?

Comparison: Caucasian vs. African American females

Outcome: To decrease high blood pressure which can lean to preeclampsia, eclampsia or HELLP syndrome in pregnancy

Preeclampsia

A multisystem disorder characterized by elevated blood pressure and proteinuria that is unique to human pregnancy.› Because the cause is largely hypertension, it

is more frequently seen in African American patients, women of maternal age or obese.

The Magpie trial Collaborative Group, 2002 did an international large controlled, randomized study of 10,110 women to evaluate the effects of MgSo4 on women and their babies Conclusion: MgSo4 therapy halves the risk of

eclampsia, and reduces risk of placental abruption by 27% and the risk of maternal death by 45%.

Eclampsia

Commonly defined as a new onset of Grand-Mal seizure activity in pregnant women that are not otherwise related to an existing brain condition.

Muscle aches and pains Seizures Severe agitation Unconsciousness Severely elevated BP’s Eclampsia follows a pre-existing condition called

preeclampsia with elevated BP’s, excess and rapid weight gain (>2lbs/wk).

HELLP Syndrome

H - hemolysis (breaking down of red blood cells)

EL – elevated liver enzymes LP – low platelet count

› Most common reason for mothers to get ill or die are liver rupture or stroke cerebral edema or cerebral hemorrhage

Nursing Plan/Implementation

Monitor BP’s (SBP >140 and/or DBP >90) Assess reflexes Assess edema Ask about visual disturbances Monitor lab values – CBC, CMP, Uric Acid, LDH Check for proteinuria Manage medications

MgSo4 IV infusion IV push drugs – Labetalol, Hydralazine Oral medications – Niphedipine, Labetalol, Aspirin,

Calcium Assess for possible transfer to higher level of care

Key Points

Women with preeclampsia or eclampsia have higher risk of:

Preterm delivery that can lead to complications in the baby Placental abruption of placenta from the uterus

Blood clotting problemsEarly diagnosis of HELLP syndrome is crucial because

the morbidity/mortality rates associated with this syndrome can be as high as 25%.

Most often the definitive treatment for these complications are delivery of baby and placenta. Transfusions of some form of blood product is often needed –red cells, platelets or plasma.

Conclusion

Unfortunately there is still no tool to aid the early diagnosis of pre-eclampsia; therefore pregnant women will continue to present with severe pre-eclampsia and will require quick and effective management from a collaborative team of healthcare professionals. › This disease can come on quick and if symptoms are

not related to the physician, it can have devastating effects on the patient and her unborn child

Preeclampsia (PE) is a serious multisystem disorder in pregnancy and is a leading cause of maternal and fetal morbidity and mortality worldwide (Wiebke, Sarosh & Holger, 2013).

REFERENCES

Altman, D., Carroli, G., Duley, L., Farrell, B., Moodley, J., Neilson, J., & Smith, D. (2002). Do women with pre-eclampsia, and their

babies, benefit from magnasium sulphate? the magpie trial: a randomized placebo- controlled trial. Europepmc, 359(9321), 1877-1890. Retrieved from http://www.europepmc.org

Eiland, E., Nzerue, C., & Faulkner, M. (2012). Preeclampsia 2012. Hindawi publishing corporation: Journal of Pregnancy, 2012, 7 pages. doi: 10.1155/2012/586578

Foundation, P. (November, 2013 25).  HELLP syndrome. Retrieved from http://www.preeclampsia.org/health-information/hellp

Health, U.D. (October, 2013 31). Eclampsia. Retrieved from Medline Plus: http://www.nlm.nih.gov/medlineplus/ency/article/000899.htm

(n.d.). Retrieved from http://www.nursing-theory.org Morley, A. (2004). Pre-eclampsia: Pathophysiology and its

management. British journal of midwifery, 12(1), 30-37. Wiebke, S., Sarosh, R., & Holger, S. (2013). The course of angiogenic

factors in early- vs. late onset preeclamppsia and HELLP syndrome. Perinatal Med.,41(5), 511-516. doi: 10.1515