★ HELLP syndrome 헬프신드롬, gestational hypertension 임신성 고혈압

HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets) syndrome

• Hemolysis
• Elevated Liver enzymes
• Low Platelet counts

 

- Life-threatening disorder of pregnancy
- Often considered a variant of preeclampsia, HELLP syndrome can develop without hypertension or proteinuria.
- Clinical manifestations may include elevated liver enzymes and RUQ pain due to swelling of the liver that can lead to liver rupture, malaise, nausea, and a platelet count <100,000/mm3 (<100 × 109/L).

 

- If HELLP syndrome is suspected, the nurse should immediately notify the health care provider because medical intervention is required to facilitate birth as soon as possible (eg, labor induction) to prevent severe complications (eg, placental abruption, disseminated intravascular coagulation) or death.

 

- Epidural anesthesia may be contraindicated in clients with a decreased platelet count due to the risk for bleeding at the puncture site, which may lead to hematoma formation, spinal cord compression, and neurologic dysfunction.

 

 

Hypertensive disorders of pregnancy
Chronic hypertension	Systolic pressure ≥140 mm Hg &/or diastolic pressure ≥90 mm Hg prior to conception or at <20 weeks gestation
Gestational hypertension	New-onset elevated blood pressure at ≥20 weeks gestation No proteinuria or signs of end-organ damage
Preeclampsia	New-onset elevated blood pressure at ≥20 weeks gestation     AND Proteinuria OR signs of end-organ damage Headache, vision change, swollen face, feet, hands, pitting edema, RUQ pain, hyperreflexia, clonus
Eclampsia	Preeclampsia     AND New-onset tonic-clonic seizures, coma

 

 

Gestational Hypertension → preeclampsia → eclampsia

New-onset elevated BP at 20 weeks gestation

No proteinuria or other signs

BP 140 이상 or >90 DBP

restircted fetal growth

placental insuffieciency or abruption

maternal stroke 

pulmonary edema

maternal or fetal death

 

Intervention 

Monitor BP: report for elevated BP, especially if severe (ie. SBP>160 DBP>110)

Monitor weigh: indicator of fluid retension associated with preeclampsia

Report symptoms (eg. headache, vision change): vision change, sever headache, epigastric pain 은 결코 hypertension의 expected증상이 아니다. preeclampsia 의 전조 증상이니 잘 관찰하고 보고할 것.

Monitor daily fetal kick counts and report decreased movement, this is strong indicator of fetal oxygenation

Anticipate induction of labor

measure intake and output

test for proteinuria

 

GH 환자에게 치료법이 inductino of labor 가 될 수 있다. 특히 maternal or fetal distress 가 있을 때! 하지만 꼭 C/S 이 답인 것은 아니다.