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Eclampsia & HELLP (haemolysis, elevated liver enzymes, low platelets)…
Eclampsia & HELLP (haemolysis, elevated liver enzymes, low platelets) Syndrome
Eclampsia
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Fits may occur antenatally (38%), intrapartum (18%) or postnatally usually w/in first 48hrs (44%)
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HELLP Syndrome
Definition: A serious complication regarded as a variant of severe PE which manifests w/ haemolysis, elevated liver enzymes, and low platelets.
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Symptoms:
- Epigastric / RUQ pain (65%)
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- Urine is "tea coloured" due to haemolysis
Signs:
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- Increased BP and other features of PE
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Treatment is supportive and as for eclampsia, MgSO4 (magnesium sulphate) is indicated.
Although platelets are very low, platelet infusions are only required if bleeding, or for surgery and <40.
Management of Eclampsia
- Basic principles of airway, breathing and circulation plus IV access.
- Most eclamptic fits are short-lasting and terminate spontaneously.
- MgSO4 (magnesium sulphate) is the drug of choice for both control of fits and preventing (furhter) seizures.
- Loading dose of 4g should be given over 5-10mins followed by an infusion of 1g/h for 24hrs.
- If further fits occur, a further 2g can be given as a bolus (the therapeutic range for Mg is 2-4mmol/L).
- In repeated seizures, use diazepam (if still fitting, the patient may need intubation and ventilation and imaging of the head to rule out a cerebral haemorrhage)
- Strict monitoring of the patient is mandatory.
- Pulse, BP, respiration rate and oxygen saturations every 15 mins.
- A urometer and hourly urine.
- Assessment of reflexes every hour for Mg toxicity (usually knee reflexes, but use biceps if epidural in situ)
- Mg toxicity is characterized by:
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- Half / stop infusion if oligouric (<20ml/hr) or raised creatinine and seek senior/renal advice.
- If toxic, give 1g calcium gluconate over 10min.
- If hypertensive (BP>160/110) give BP-lowering drugs:
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- IV labetalol (methyldopa if asthmatic)
- Fluid restrict patient to 80ml/hr or 1ml/kg/hr due to risk of pulmonary oedema (even if oligouric, the risk of renal failure is small); monitor the renal function with the creatinine.
- A CVP line may be needed if there has been associated maternal haemorrhage and fluid balance is difficult or if the creatinine rises.
- Fetus should be continuously monitored with CTG.
- Deliver fetus once the mother is stable.
- Vaginal delivery is not contraindicated if cervix is favourable.
- If HELLP syndrome co-exists, consider high-dose steroids and involvement of renal and liver physicians.
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Impending Eclampsia
Management:
- Induction of Labour (IOL)
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- Antihypertensive, if >/=160/100-110mmHg
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