Preeclampsia, Eclampsia, and HELLP Syndrome for Certified Emergency Nursing (CEN)
Included In This Lesson
Outline
Preeclampsia, Eclampsia, and HELLP Syndrome
Definition/Etiology:
Preeclampsia usually presents >34 weeks, and is characterized by new-onset hypertension/proteinuria or hypertension/end-organ dysfunction.
During pregnancy, HTN is SBP >140 or DBP >90. Severe HTN is SBP >160 or DBP>110.
Eclampsia is a new-onset tonic-clonic seizure or coma in a patient with preeclampsia who does not already have another neurological cause for seizures.
HELLP is a syndrome in pregnant or post-partum women who develop Hemolysis, Elevated Liver enzymes, and Low Platelets. Symptoms usually resolve at birth, which is commonly preterm. Complications are usually related to bleeding.
There is some overlap between pre-eclampsia, eclampsia, and HELLP, but it is not a continuum.
Pathophysiology:
Preeclampsia and eclampsia are caused by abnormal development of blood vessels in the placenta.
Cause of seizures and development of eclampsia is unclear. It can also occur in the first/second week post-partum.
Pathogenesis of HELLP is unclear. Patients develop small clots in small vessels, causing acute kidney injury and liver injury. It can be similar to DIC (disseminated intravascular coagulopathy).
Clinical Presentation:
Preeclampsia/Eclampsia:
- Headache
- Altered mental status
- Visual changes
- Pulmonary edema (dyspnea, orthopnea, pink/frothy sputum)
- Hyper-reflexia
- Oliguria
- Seizure (in eclampsia)
- Fetal bradycardia is common after maternal seizure
HELLP:
- Rapid onset, usually late 2nd trimester, but sometimes can be post-partum
- RUQ/epigastric pain
- Elevated AST/ALT
- Nausea/vomiting
- Occasional jaundice/ascites
- >140/90 in 85% of cases
- Proteinuria in 85% of cases
HELLP mortality related to:
- Placental abruption
- Liver hematoma
- Acute kidney injury
- DIC develops in 21% of cases
Collaborative Management:
Testing:
- CMP, coags, CBC, type/cross
- Peripheral blood smear (looks for fragmented RBCs)
- Urinalysis with micro
- Fetal monitoring
- Fetal ultrasound
- Uterine ultrasound
- Liver ultrasound
- Chest x-ray
Medications:
- Labetalol drip to manage BP
- Low-dose aspirin can sometimes prevent preeclampsia.
- Magnesium drip to prevent seizures and for fetal neuroprotection
HELLP:
- Monitor RUQ pain, which could indicate hepatic rupture. Can radiate to back and shoulder.
- Monitor for hypovolemic shock (hypotension with tachycardia).
- Surgical team experienced in liver trauma
Eclampsia:
- Neuro consult
- Maternal oxygen if seizing
- Brain MRI
- EEG
Evaluation | Patient Monitoring | Education:
- Monitor for hypovolemic shock
- Continuous maternal cardiac monitor
- Fetal heart rate monitor
- Serial labs
- Protect from trauma in seizure
- Continuous oxygen saturation monitoring
- Maternal oxygen PRN
Linchpins: (Key Points)
- Delivery is the cornerstone of treatment.
- HELLP can develop DIC.
- Preeclampsia can look like heart failure.
- Add maternal oxygen during seizures.
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- August, P. (2022, August 29). Preeclampsia: Clinical features and diagnosis. UpToDate. https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis
- Norwitz, E. R. (2022, October 13). Eclampsia. UpToDate. https://www.uptodate.com/contents/eclampsia
- Norwitz, E. R. (2022, August 10). Preeclampsia: Antepartum management and timing of delivery. UpToDate. https://www.uptodate.com/contents/preeclampsia-antepartum-management-and-timing-of-delivery
- Sibai, B. M. (2022, April 6). HELLP syndrome: Hemolysis, elevated liver enzymes and low platelets. UpToDate. https://www.uptodate.com/contents/hellp-syndrome-hemolysis-elevated-liver-enzymes-and-low-platelets
Study Guide pre LPN-RN
Concepts Covered:
- Cardiac Disorders
- Cardiovascular
- Emergency Care of the Cardiac Patient
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Central Nervous System Disorders – Brain
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- Respiratory
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- Delegation
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- Acute & Chronic Renal Disorders
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- Disorders of the Adrenal Gland
- Documentation and Communication
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- Intraoperative Nursing
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- Urinary Disorders
- Integumentary Disorders
- Musculoskeletal Disorders
- Circulatory System
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- Neurological Emergencies
- Disorders of Thermoregulation
- Neurological Trauma
- Basics of NCLEX
- Fundamentals of Emergency Nursing
- Integumentary Important Points
- Multisystem
- Test Taking Strategies
- Tissues and Glands
- Urinary System
- Emergency Care of the Neurological Patient
- Neurologic and Cognitive Disorders
- Central Nervous System Disorders – Spinal Cord
- Renal and Urinary Disorders
- Nervous System
- Respiratory Disorders
- Respiratory System
- Infectious Disease Disorders
- EENT Disorders
- Emergency Care of the Respiratory Patient
- Health & Stress
- Skeletal System
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- Digestive System
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- Endocrine and Metabolic Disorders
- Muscular System
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- Basics of Human Biology
- Adult
- Anxiety Disorders
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- Dosage Calculations
- Understanding Society
- Concepts of Pharmacology
- Newborn Care
- Adulthood Growth and Development
- Pregnancy Risks
- Postpartum Complications
- Substance Abuse Disorders
- Bipolar Disorders
- Learning Pharmacology
- Psychotic Disorders
- Prenatal Concepts
- Prefixes
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- Fetal Development
- Terminology
- Proteins
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- Med Term Basic
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- Labor Complications
- Labor and Delivery
- Postpartum Care
- Hematologic Disorders
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- Oncologic Disorders
- Eating Disorders
- Personality Disorders
- Trauma-Stress Disorders
- Developmental Considerations
- Concepts of Mental Health
- Psychological Emergencies
- Somatoform Disorders
- Prioritization
- Factors Influencing Community Health
- Community Health Overview