Preeclampsia, Eclampsia & HELLP Syndrome in Pregnancy

1. Preeclampsia, Eclampsia & HELLP Syndrome in Pregnancy State University of New York Institute of Technology Svetlana Avsyanik, RN

2. 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)

3. 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

4. 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%.

5. 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).

6. 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

7. 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

8. 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 problems Early 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.

9. 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).

10. 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 magnasiumsulphate? 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 angiogenicfactors in early- vs. late onset preeclamppsiaand HELLP syndrome. Perinatal Med.,41(5), 511-516. doi: 10.1515