OB Exam 4- Eclampsia and HELLP Syndrome

Eclampsia

convulsions or coma not from other causes in a preeclamptic women with no history of preexisting seizure related pathology that can occur during pregnancy or immediately PP

Eclampsia symptoms

seizure,cerebral vasospasm, hemorrhage, ischemia, edema, and platelets and fibrin clots that occlude cerebral vasculature

Premonitory signs of Eclampsia

persistent headache and blur vision, epigastric or RUQ pain, altered mental status

Immediate care of eclampsia

ensure patent airway and safety, note time of onset and duration of seizure, call for help, remain at bedside

Complication of eclampsia

periods of hypoxia in mother and fetus, risk of aspiration, CVA, cerebral edema, anorexia, coma, maternal death

HELLP syndrome

Hemolysis, elevated liver enzymes (ALT &AST), and lower platelets

HELLP labs

CBC, CMP, uric acid increase, BUN increase, 24 urine for protein and creatinine clearance

HELLP Patho

RBC are destroyed as they travel through constricted vessels causing hemolytic anemia, RBC morph, reduced oxygen carrying capacity, and elevated bilirubin and jaundice d/t hemolysis of RBC, and elevated liver enzymes

HELLP Complications

eclampsia, abruption of placenta, DIC, acute renal failure, pulmonary edema, acute adult RDS, cerebral hemorrhage, stroke

HELLP Syndrome Tx

need an emergency c-section (done in 30 min)- not time for spinal contraindicated with low platelets will use general anesthesia

HELLP Syndrome postpartum tx

might need a platelet or whole blood transfusion

Cerebral hemorrhage signs

progressive decrease in LOC, complaint of flashing lights, focal neurological deficits, new onset vomiting, sudden increase in BP

Focal neuro deficit in cerebral hemorrhage

nuchal rigidity, seizure, slurring of speech, local or unilateral motor weakness

Cardiovascular change in HTN

HTN d/t elevated systemic vascular resistance and left ventricle working hard, fluid shifts from intravascular to extravascular d/t endothelial dysfunction and increased capillary permeability, and leaking of albumin and other plasma proteins d/t endothelial dysfunction

Renal changes in HTN

vasospasm d/t decrease in renal blood flow and GFR, glomerular membrane is damaged from vasoconstriction which increases permeability to proteins

Oliguria

intravascular fluid volume depletion, renal vasospasm, decreased cardiac output d/t vasospasm and increased vascular resistance, specific gravity may decrease as kidneys loose concentration ability

Postpartum with HTN disorder

auto transfusion and extravascular to intravascular fluid shifts cause drop in COP d/t dilution

Greatest risk for pulmonary edema PP

6-24 hrs after delivery

CNS in HTN disorders

HA in pregnancy question cerebral vasoconstriction as it leads to cerebral ischemia, seizure, and hemorrhage

Vision changes in HTN

Retinal arteriolar spasms, Petechial hemorrhages, Retinal edema, Retinal detachment(Can result in permanent blindness)

Hematologic changes in HTN disorders

hemoconcentration and thrombocytopenia

Platelet in HTN disorders

Platelet count usually returns to normal within 72 hours PP, count is okay but function may not be normal d/t medications such as mag, ASA, and steroids

Magnesium Sulfate

preferred drug for preventing and treating eclamptic seizure, improves cerebral circulation and perfusion

What does Magnesium sulfate interfere with

platelet aggregation predisposes to bleeding

Magnesium sulfate change in serum osmolarity

may increase risk for pulmonary and cerebral edema

Magnesium contraindications

myasthenia gravis, heart block, myocardial insufficiency, and renal disease

Magnesium excretion

excreted via kidneys, oliguria or elevated serum creations levels may lead to high levels

When is cardiac monitoring necessary with magnesium's

when given with IV labetalol as it can cause bradycardia and dysrhythmia

Magnesium bolus dose

4-6grams over 20-30 minutes

Magnesium maintained infusion dose

2-4mg

Use Magnesium cautiously with

Other CNS depressants(barbiturates and narcoticosis)

Normal Magnesium level

1.5-2

Therapeutic magnesium level

4-7

Cardiac arrest magnesium level

25

How often to take Mag levels

Q6hrs unless concern

Magnesium side effects

“feel yucky- flushing, lethargy, nausea, distressed reflex, depressed platelet aggregation, cardiac dysrhythmia, respiratory paralysis, circulatory collapse, diaphorase, blur vision, hypocalcemia

Magnesium nursing intervention

I&O, vitals q5-15 with loading dose and q30-60 depending on status, hourly reflex, monitor for toxicity, provide seizure precautions, assess lung sounds, loch, incisional bleeding, neuro status, mag levels

Magnesium worsening conditions sxs

shock, respiratory distress, arrhythmia, DIC sxs

Antidote for magnesium

Calcium Gluconate or Calcium chloride