Pre-eclampsia, Eclampsia and
HELLP syndrome
Dr. AMRO BANNAN
OBS-GYNE DEMONSTRATOR
KING ABDULAZIZ UNIVERSITY
HOSPITAL
Pre-Eclampsia
Definition-
“a disorder associated with pregnancy
consisting of hypertension, proteinuria and
new-onset dependent oedema, most
commonly after 20 weeks of gestation”
Eclampsia
Definition-
“pre eclampsia complicated with
seizures”
Diagnosis
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Hypertension- syst > 140mmHg
or 30mm above pre-preg
diastolic > 90 mmHg
or 15mm above pre-preg
Two abnormal measurements, on two
occasions, more than 6 hours apart
Epidemiology
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Freq (US)
pre-eclampsia: 6-8% of pregnancies
eclampsia: 0.05-0.2%
Aetiology
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Exact pathophysiology unknown
Possible causes
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dysfunction of the uteroplacental bed leading
to vasoconstriction, platelet aggregation and
hypercoagulability
altered CoV reactivity, vasospasm,
microthrombi, implantation problems,
hypertension etc
Mortality/Morbidity
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Maternal: 8-36% most frequently related
to seizure activity
Foetal: 13-30% most frequently related to
iatrogenic prematurity
Symptoms
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Headache
Oedema
Visual disturbance
Focal neurology, fits, anxiety, amnesia
Abdo pain
SOBOE
Decreased urine output
None
Signs
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Hypertension
Tachycardia and tachypnoea
Creps or wheeze on auscultation
Neurological deficit
Hyperreflexia
Petechiae, intracranial haemorrhage
Generalised oedema
Small uterus for dates
Risk Factors
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Low socioeconomic class
Multiple foetuses, or hydatid
Maternal age <20 or >35yrs
Primip
Gestational or pre-gestational DM
Renal disease
Afro Caribbean- twice as likely
Family history- four times the risk
Investigation
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Hypertension
Urinalysis- proteinuria greater than 2+
Blood tests
CT head
Foetal USS
Treatment
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ABC, BZD’s for seizures
Hypertension alone- not true preeclampsia but need follow-up
Hypertension and proteinuria- preeclampsia must be ruled out, d/w O&G
Severe pre-eclampsia-as if eclampsia,
careful BP control, Mg, delivery. O&G/ITU
Complications/prognosis
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Permanent neuro damage
Renal insufficiency
Abruption
Death
25% of eclamptics will be so in future
pregnancies
Increased risk of essential hypertension
HELLP syndrome
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Undiagnosed pre-eclampsia progresses to
causeHaemolysis
Elevated Liver enzymes
Low Platelets
May also occur de novo
HELLP 2
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Incidence-
0.1-0.6% of pregnancies
4-12% of pre-eclampsia
Similar to pre-eclampsia with
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RUQ/epigastric pain
Jaundice
Microangiopathic anaemia
Deranged LFT’s
Treatment- ABC, O&G, admit, deliver