ObGyn - Preeclampsia and Eclampsia

The occurrence of convulsions unrelated to other cerebral conditions with evidence of preeclampsia. Occurs in 2-4% of preeclamptics.

Its occurrence is usually unpredictable, but is usually associated with significant proteinuria. Headache, visual symptoms, and RUQ/epigastric pain are the most common premonitory symptoms. Convulsions are usually short, lasting 60-75 seconds.

Treatment consists of the usual ABCs and MgSO4.

Used to diagnose preeclampsia in addition to the presence of proteinuria.

BP = 140/90 after 20 weeks gestation (elevation must be present on 2 measurements taken at least 6 hours apart to avoid spurious results)

The diagnosis based on hypertension as well as the presence of proteinuria.

BPs = 140/90 after 20 weeks gestation (2 measurements at least 6 hours apart)

Proteinuria = 300 mg of spilled protein in a 24 hour urine collection or 0.1g/L on a spot specimen (urine dipstick)

Hypertension present before pregnancy or before 20 weeks gestation. Hypertension persisting for more than 6 weeks postpartum is also classified as chronic HTN.

Gravidas with this are at risk for developing superimposed preeclampsia and that diagnosis is made by a change in hypertension accompanied by proteinuria.

Development of HTN during pregnancy or immediately postpartum without other signs of preeclampsia or preexisting HTN.

Stands for hemolysis, elevated liver enzymes, and low platelets. It is a unique variant of preeclampsia (2-12%) and is considered to be evidence of severe preeclampsia. It can involve DIC, periportal liver necrosis and hemorrhage, and microangiopathic hemolytic anemia. Rarely, complications of HELLP can include hypoglycemia, coma, nephrogenic diabetes insipidus, subcapsular liver hematoma.

Unlike "normal" preeclampsia, HELLP can present with little or no HNT or proteinuria. More than half present with epigastric/RUQ pain or nausea/vomiting.

BP > 160/110
Proteinuria = 5 grams/24 hour urine collection or dip of +3 to +4
Oliguria
Cerebral or visual disturbances
Epigastric pain
Pulmonary edema
Impaired liver function
Thrombocytopenia
Eclampsia