Definition

pre-eclampsia: BP > 140/90 + proteinuria +- edema after 20/52 of gestation
Syn: EPH gestosis 

eclampsia: sudden onset of tonic clonic seizures

HELLP: Severe pre-eclampsia/eclampsia with haemolysis, elevated LFTs and low plt

Aetiology

unclear, ? chronic hypertension, ? diabetes, ? multiple gestation 

Pre-eclampsia: 4-5% of all pregnancies in last trimenon
eclampsia:85% during labour, 15% post partum

HELPP 70% prepartal, 30% postpartal

maternal mortality 2%, fetal mortality 7%

Pathology

Relative placentar ischemia > Trigger for diffuse endothelial activation

Clinical Signs

criteria for pre-eclampsia: 

            RR>140/90, proteinuria >2g/24h

criteria for severe pre-eclampsia

            BP> 160/110, proteinuria >5g/24h, oliguria <500ml/24h, á urea, CNS syptoms: nausea, headache
criteria for HELLP
            upper GI pain (RUQ) !!!!, á LFTs, edema, plt< 10000/mcl,  áweight, haemolysis (â        haptoglobin, áLDH, ábili)

Complications

Intrauterine fetal asphyxia, DIC, haemorrhage (cns, liver, adrenal glands), shock, liver rupture

Management

Liver US (on admission), Lab (FBE, LFT, haptoglobin ), urine (protein), CTG,

Therapy

Delivery            vaginal or caesarean sectio
Sedation           Diazepam

Antihypertensive           beta-blocker (labetalol – others âplacentar flow ), CA (nifedipine),         Hydralazine,

Anticonvulsive  MgSO4 (ini 1-2-4g, then 1g/h for 24hrs) 2-3.5mmol/l
            signs of OD:â Reflexes, âRR, flush (therapy of OD: CaGlu 10mmol iv)