PRE ECLAMPSIA

&
HELLP SYNDROME
 Classification of the Hypertensive Disease in Pregnancy.

Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 4 (2014) 105–145

 Classification of the Hypertensive Disease in Pregnancy.

Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 4 (2014) 105–145

Diagnostic Criteria for Preeclampsia

Hypertension in Pregnancy, ACOG 2013

Severe Features of Preeclampsia
(Any of these findings)

Hypertension in Pregnancy, ACOG 2013

 HELLP syndrome

The HELLP syndrome is a serious complication in pregnancy

characterized by haemolysis, elevated liver enzymes and low
platelet count occurring in 0.5 to 0.9% of all pregnancies and in
10–20% of cases with severe preeclampsia.

BMC Pregnancy and Childbirth 2009, 9:8

Main diagnostic criteria of the HELLP syndrome

Partial HELLP includes

presence of any 2 of the 3
criteria – can be managed
by conservative treatment.
Full HELLP includes all of
the 3 criteria
- high risk group for
complications like DIC and
should be considered
delivery within 48 hours.

BMC Pregnancy and Childbirth 2009, 9:8

 Complications of HELLP syndrome
Maternal complications Foetal/neonatal complications
Eclampsia Perinatal death
Abruptio placentae IUGR
DIC Preterm delivery4
Acute renal failure Neonatal thrombocytopenia 5 RDS
Severe ascites
Cerebral oedema
Pulmonary oedema
Wound hematoma/infection2
Subcapsular liver hematoma Liver rupture
Hepatic infarction Recurrent thrombosis
Retinal detachment
Cerebral infarction
Cerebral Haemorrhage
Maternal death
BMC Pregnancy and Childbirth 2009, 9:8
 Management of HELLP syndrome
In general, there are three major options for the management of
women with severe preeclampsia and HELLP syndrome

1) Immediate delivery which is the primary choice at 34 weeks'

gestation or later.
2) Delivery within 48 hours after evaluation, stabilization of the
maternal clinical condition and CS treatment. At 27 to 34 weeks of
gestation, this option appears appropriate and rational for the
majority of cases.
3) Expectant (conservative) management for more than 48–72 hours
may be considered in pregnant women before 27 weeks' gestation.
In this situation, CS treatment is often used, but the regimens vary
considerably.
BMC Pregnancy and Childbirth 2009, 9:8
 Corticosteroid treatment for the women with
HELLP syndrome

Present alternatives for CS treatment are:

1) standard CS treatment to promote foetal lung maturity
2) high-dose dexamethasone treatment of the mother
or
3) treatment with repeated doses to reduce maternal mor-
bidity and hastening recovery.

BMC Pregnancy and Childbirth 2009, 9:8

Favourable effects of CS treatment :

• Accelerate maturation of the foetal lungs,

• Diminished oedema,
• Inhibited endothelial activation
• Reduced endothelial dysfunction,
• Prevention of thrombotic microangiopathic anaemia,
• Inhibition of cytokine production  induce anti-
inflammatory effects.

BMC Pregnancy and Childbirth 2009, 9:8

 The origins and consequences of preeclampsia.

Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 4 (2014) 105–145

A PROPOSED LINK BETWEEN OBESITY AND MATERNAL HYPERTENSION IN PREGNANCY

Biomolecules 2015, 5, 3142-3176

 Prepregnancy BMI is associated with an increased risk of preeclampsia

Data from the Perinatal Collaborative Study including more than 19,000 Black and
19,000 white women was analyzed and the unadjusted prevalence of preeclampsia as
related to prepregnancy BMI presented.
Pregnancy Hypertens. 2011 January 1; 1(1): 6–16
 Asymmetric Dimethylarginine (ADMA) has been proposed
as a risk factor for increased the risk of preeclampsia in obesity

Pregnancy Hypertens. 2011 January 1; 1(1): 6–16

 “Stress Hyperglycemia” Exacerbates Illness

Illness
Illness
 Stress hormones
cortisol, norepinephrine, Hemodynamicinsult
Hemodynamic insult
epinephrine, glucagon,
growth hormone, prolactin,  Hepatic Glucose Electrolytelosses
Electrolyte losses
serotonin, neuropeptide Y, Production
ACTH, CRH Oxidative
Oxidative stress
+ stress
Myocardialinjury
Myocardial injury
Hypercoagulability
Hypercoagulability
FFAs
 Glucose Altered immunity
Altered immunity
 Fatty Acids
Wound
Woundhealing
healing
 Inflammation
Inflammation
Lipolysis
Endothelial
Endothelialfunction
function
 Glucose Uptake

FFAs

AACE 2013
Pathogenetic Pathways Involved in Disseminated Intravascular
Coagulation

The New England Journal of Medicine, August 19th 1999

Blood Smear (Panel A) and Kidney-Biopsy Specimen (Panel B) from
a Patient with Disseminated Intravascular Coagulation.

In Panel A, the arrows indicate typical fragmented red cells (schistocytes). In Panel B,
intravascular fibrin is present in a small arteriole (arrow).

The New England Journal of Medicine, August 19th 1999