Hypertensive disorders of pregnancy complications and chronic hypertention in pregnancy II

Complication of severe pre-eclampsia are:
• Eclampsia
• HELLP syndrome
• DIC
• ARDS
• Pulmonary oedema
• Acute renal failure
• Placental abruption
• Intrauterine growth restriction (IUGR)
• Intrauterine fetal death

Eclampsia:
defined as new-onset tonic-clonic seizure in an otherwise healthy woman with hypertensive disorder of pregnancy, is a significant complication of preeclampsia and is associated with high maternal and neonatal morbidity and mortality.
Of seizures 44% occur postnatally, 38% antepartum & 18% intrapartum. The pathophysiology is thought to involve cerebral vasospasm leading to ischaemia & cerebral oedema.

Diagnosis:
Eclamptic seizures classically occur in the second half of pregnancy & up to 10 days postpartum. They are tonic-clonic followed by a brief period of coma. Many women manifest excitability or hyper-reflexia prior to the onset of seizure. The diagnosis of eclampsia is straight forward if the woman had PE, some have not established proteinuria & hypertension before the first fit.