Preeclampsia, HELLP syndrome and eclampsia are part of a spectrum of hypertensive disorders specific to pregnancy. Hypertensive disorders in pregnancy are a leading cause of maternal and fetal morbidity worldwide. The root cause of hypertensive disorders specific to pregnancy is the placenta. As the cytotrophoblastic tissue of the placenta fails to widen the maternal spiral arteries – this is called decreased spiral remodeling. This causes decreased tissue perfusion (ischemia) in the placenta, called defective placentation. Ischemia in the placenta is thought to stimulate release of a substance that is toxic to endothelial cells, leading to endothelial cell dysfunction. Because endothelial cells line all the blood vessels, this leads to multiorgan system involvement. Destruction of endothelial cells in the blood vessels causes decreased production of vasodilators such as prostacyclin and nitric oxide. (High risk pregnancy) Preeclampsia affects 2 to 7 percent of first time mothers, and is most common in mothers younger than 19 or older than 40. Eclampsia refers to the onset of seizures and coma in a pregnant woman who has preeclampsia. Eclampsia can be triggered by severe cerebral vasospasm, hemorrhage, ischemia, or edema. (High risk pregnancy). HELLP syndrome develops in five percent of patients with preeclampsia, and is considered a variant of preeclampsia rather than a separate disorder.
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HELLP syndrome occurs when endothelial damage is severe enough that it exposes the basement membrane, which causes platelet adherence and fibrin deposition. This causes platelet levels to decrease, and RBCs are damaged while moving through the narrowed vessels. Endothelial damage and fibrin deposits in the liver can lead to impaired liver function and hemorrhagic necrosis. Symptoms of hemorrhagic necrosis include upper right quadrant pain, nausea, and vomiting. Hemorrhagic necrosis can cause elevate liver enzymes. (High risk pregnancy). A diagnosis of HELLP syndrome is associated with an increased risk of maternal death. Symptoms The defining symptoms of preeclampsia are elevated blood pressure with proteinuria without evidence of a urinary tract infection (lowdermilk). Increased blood pressure can cause the patient to experience headaches, cerebral or visual disturbances, pulmonary edema or cyanosis, rapid onset of edema of the face. The patient may also experience oliguria – urine output of less than 30 mL/hr – which will cause fluid retention. Because increased blood pressure will also cause constriction of vessels that carry oxygen and nutrients to the fetus, the fetus will exhibit , and intrauterine growth restriction. The mother will also experience hyperreflexia, nausea and vomiting, right upper quadrant pain, and impaired liver function. Symptoms of HELLP syndrome include hemolysis: micro-angiopathic hemolytic anemia, elevated liver enzymes, low platelets. HELLP is considered a variant of preeclampsia, but may not present with elevated blood pressure or protein in the urine, making it difficult to diagnose. (Lippincott). Patients with HELLP syndrome may also experience malaise, epigastric pain, nausea and vomiting, and viral syndrome-like symptoms. They may also experience hematuria and jaundice (high-risk). Symptoms of impending eclampsia include severe persistent headache, visual disturbances, epigastric pain, and restlessness. (High risk pregnancy) Diagnosis Mild preeclampsia is systolic BP greater or equal to 140 mmHg or diastolic BP greater than or equal to 90 on more than 2 occasions. Gestational proteinuria of greater than 300 mg on random specimen or greater than 1+ on dipstick; urinary excretion greater than or equal to 0.3 g protein in a 24-hour specimen. Severe is diagnosed if preeclampsia is evident and at least one of the following is present: systolic BP greater than or equal to 160; diastolic greater than or equal to 110; proteinuria 5 g or greater in 24-hour collection or 3+ on two or more random urine specimens. (Lippincott) To accurately assess blood pressure, measure when the woman is in the same position every time, whether sitting or lying with the arm at heart level (Lowdermilk). Allow the woman 10 minutes to rest before taking the blood pressure, and …show more content…
These patients have a significantly increased risk of developing preeclampsia in subsequent pregnancies, and even if they maintain normal blood pressure readings throughout their pregnancy, they are at increased risk of preterm birth, small for gestational age infant, and perinatal death.
Development of eclampsia puts the patient at increased risk of developing epilepsy and cognitive impairment later in
HELLP syndrome occurs when endothelial damage is severe enough that it exposes the basement membrane, which causes platelet adherence and fibrin deposition. This causes platelet levels to decrease, and RBCs are damaged while moving through the narrowed vessels. Endothelial damage and fibrin deposits in the liver can lead to impaired liver function and hemorrhagic necrosis. Symptoms of hemorrhagic necrosis include upper right quadrant pain, nausea, and vomiting. Hemorrhagic necrosis can cause elevate liver enzymes. (High risk pregnancy). A diagnosis of HELLP syndrome is associated with an increased risk of maternal death. Symptoms The defining symptoms of preeclampsia are elevated blood pressure with proteinuria without evidence of a urinary tract infection (lowdermilk). Increased blood pressure can cause the patient to experience headaches, cerebral or visual disturbances, pulmonary edema or cyanosis, rapid onset of edema of the face. The patient may also experience oliguria – urine output of less than 30 mL/hr – which will cause fluid retention. Because increased blood pressure will also cause constriction of vessels that carry oxygen and nutrients to the fetus, the fetus will exhibit , and intrauterine growth restriction. The mother will also experience hyperreflexia, nausea and vomiting, right upper quadrant pain, and impaired liver function. Symptoms of HELLP syndrome include hemolysis: micro-angiopathic hemolytic anemia, elevated liver enzymes, low platelets. HELLP is considered a variant of preeclampsia, but may not present with elevated blood pressure or protein in the urine, making it difficult to diagnose. (Lippincott). Patients with HELLP syndrome may also experience malaise, epigastric pain, nausea and vomiting, and viral syndrome-like symptoms. They may also experience hematuria and jaundice (high-risk). Symptoms of impending eclampsia include severe persistent headache, visual disturbances, epigastric pain, and restlessness. (High risk pregnancy) Diagnosis Mild preeclampsia is systolic BP greater or equal to 140 mmHg or diastolic BP greater than or equal to 90 on more than 2 occasions. Gestational proteinuria of greater than 300 mg on random specimen or greater than 1+ on dipstick; urinary excretion greater than or equal to 0.3 g protein in a 24-hour specimen. Severe is diagnosed if preeclampsia is evident and at least one of the following is present: systolic BP greater than or equal to 160; diastolic greater than or equal to 110; proteinuria 5 g or greater in 24-hour collection or 3+ on two or more random urine specimens. (Lippincott) To accurately assess blood pressure, measure when the woman is in the same position every time, whether sitting or lying with the arm at heart level (Lowdermilk). Allow the woman 10 minutes to rest before taking the blood pressure, and …show more content…
These patients have a significantly increased risk of developing preeclampsia in subsequent pregnancies, and even if they maintain normal blood pressure readings throughout their pregnancy, they are at increased risk of preterm birth, small for gestational age infant, and perinatal death.
Development of eclampsia puts the patient at increased risk of developing epilepsy and cognitive impairment later in