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
Katies NCLEX
Concepts Covered:
- Test Taking Strategies
- Medication Administration
- Adult
- Emergency Care of the Cardiac Patient
- Microbiology
- Anxiety Disorders
- Depressive Disorders
- Nervous System
- Gastrointestinal Disorders
- Fundamentals of Emergency Nursing
- Dosage Calculations
- Understanding Society
- Circulatory System
- Concepts of Pharmacology
- Studying
- Newborn Care
- Adulthood Growth and Development
- Respiratory Disorders
- Pregnancy Risks
- Neurological
- Postpartum Complications
- Substance Abuse Disorders
- Bipolar Disorders
- Learning Pharmacology
- Psychotic Disorders
- Prenatal Concepts
- Tissues and Glands
- Factors Influencing Community Health
- Concepts of Population Health
- Community Health Overview
- Developmental Considerations
- Communication
- Legal and Ethical Issues
- Cardiovascular
- Emergency Care of the Neurological Patient
- Emergency Care of the Respiratory Patient
- Emergency Care of the Trauma Patient
- Delegation
- Multisystem
- Health & Stress
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Trauma-Stress Disorders
- Developmental Theories
- Concepts of Mental Health
- Gastrointestinal
- Newborn Complications
- Labor Complications
- Fetal Development
- Terminology
- Labor and Delivery
- Postpartum Care
- Prefixes
- Suffixes
- Proteins
- Statistics
- Med Term Basic
- Med Term Whole
- Cardiac Disorders
- Preoperative Nursing
- Intraoperative Nursing
- Vascular Disorders
- Noninfectious Respiratory Disorder
- Upper GI Disorders
- Central Nervous System Disorders – Brain
- Shock
- Immunological Disorders
- Postoperative Nursing
- Perioperative Nursing Roles
- Hematologic Disorders
- Disorders of Pancreas
- Neurological Trauma
- Neurological Emergencies
- Musculoskeletal Trauma
- EENT Disorders
- Peripheral Nervous System Disorders
- Respiratory Emergencies
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of the Thyroid & Parathyroid Glands
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Respiratory
- Acute & Chronic Renal Disorders
- Disorders of the Adrenal Gland
- Documentation and Communication
- Oncology Disorders
- Female Reproductive Disorders
- Cognitive Disorders
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Integumentary Disorders
- Urinary Disorders
- Integumentary Disorders
- Musculoskeletal Disorders
- Disorders of Thermoregulation
- Basics of NCLEX
- Integumentary Important Points
- Urinary System
- Neurologic and Cognitive Disorders
- Central Nervous System Disorders – Spinal Cord
- Renal and Urinary Disorders
- Respiratory System
- Infectious Disease Disorders
- EENT Disorders
- Eating Disorders
- Personality Disorders
- Psychological Emergencies
- Somatoform Disorders
- Prioritization
- Hematologic Disorders
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Endocrine and Metabolic Disorders
- Oncologic Disorders
- Behavior
- Emotions and Motivation
- Growth & Development
- Intelligence and Language
- Psychological Disorders
- State of Consciousness
- Basics of Sociology
- Note Taking
- Basics of Human Biology