Intensive Care Unit issues in eclampsia and HELLP syndrome

Abstract

Preeclampsia, eclampsia and HELLP syndrome are life-threatening hypertensive conditions and common causes of ICU admission among obstetric patients The diagnostic criteria of preeclampsia include: 1) systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg on two occasions at least 4 hours apart and 2) proteinuria ≥300 mg/day in a woman with a gestational age of >20 weeks with previously normal blood pressures. Eclampsia is defined as a convulsive episode or altered level of consciousness occurring in the setting of preeclampsia, provided that there is no other cause of seizures. HELLP syndrome is a life-threatening condition frequently associated with severe preeclampsia-eclampsia and is characterized by three hallmark features of hemolysis, elevated liver enzymes and low platelets. Early diagnosis and management of preeclampsia, eclampsia and HELLP syndrome are critical with involvement of a multidisciplinary team that includes Obstetrics, Maternal Fetal Medicine and Critical Care. Expectant management may be acceptable before 34 weeks with close fetal and maternal surveillance and administration of corticosteroid therapy, parenteral magnesium sulfate and antihypertensive management. Worsening condition requires delivery. Complications that can be related to this spectrum of disease include disseminated Intravascular coagulation (DIC), acute respiratory distress syndrome, stroke, acute renal failure, hepatic dysfunction with hepatic rupture or liver hematoma and infection/sepsis.

FAS A‐670G and Fas ligand IVS2nt A 124G polymorphisms are significantly increased in women with pre‐eclampsia and may contribute to HELLP syndrome: a case‐controlled study

“…We have shown for the first time the association of Fas‐670G with increased levels of the ASAT and ALAT enzymes, which are considered indicators of partial HELLP syndrome in pregnant women with pre‐eclampsia. Indeed, diagnosis of the complete form of the HELLP syndrome is characterised by the presence of all three major components, whereas the partial or incomplete form consists of only one or two elements of the components (haemolysis or elevated liver enzymes or low platelets) . In severe pre‐eclampsia, defective trophoblast invasion and placental ischaemia lead to endothelium damage, which contributes to a further increase in blood pressure and activate the coagulation cascade.…”

“…Severe pre‐eclampsia was defined as systolic BP (SBP) ≥ 160 or diastolic BP (DBP) ≥ 110 mmHg and proteinuria of ≥3 + by dipstick or ≥500 mg/24 hours. Eclampsia was defined as a convulsive episode occurring in the presence of pre‐eclampsia, provided that there was no other cause of seizures . The women included in this study had no other known pathologies apart from pre‐eclampsia.…”

“…Eclampsia was defined as a convulsive episode occurring in the presence of pre-eclampsia, provided that there was no other cause of seizures. 21 The women included in this study had no other known pathologies apart from pre-eclampsia. Infant birth complications included in our analyses were fetal intrauterine growth restriction (IUGR) and fetal death.…”

“…One of the severe complications of pre‐eclampsia is the haemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome . Interestingly, Fas‐670G has been associated with a higher risk of HELLP syndrome during pregnancy, but as yet, this has not been demonstrated in the context of pre‐eclampsia .…”

“…17,19 One of the severe complications of pre-eclampsia is the haemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. 21 Interestingly, Fas-670G has been associated with a higher risk of HELLP syndrome during pregnancy, but as yet, this has not been demonstrated in the context of pre-eclampsia. 22 As population genetic analyses may differ depending on the ethnicity, the aim of the present investigation was to evaluate the association of Fas A-670G and FasL INV2nt A 124G polymorphisms with the risk of pre-eclampsia in Tunisian women.…”