HELLP!!!

A case study presentation

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Objectives:
Definition
Risk Factors
Pathophysiology
Laboratory Values
Medications
Interventions
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Overview of Patient
Name: M.N.
Age: 27yo
Sex: Female
Address: Alabang,
Muntinlupa
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Obstetric History
Menarche: 11 3-7 days
yo LMP: January
Regular Cycle 21, 2019
No G1P0
Dysmenorrhea
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Medical History
Chief Complaint: Elevated BP
Admitting Diagnosis:
PU 28 wks 3/7 days by early
ultrasound, cephalic not in labor,
preeclampsia with severe features,
complete HELLP Syndrome, G1P0
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Medical History
5th mo->BP=140/90, diagnosed
with gestational hypertension
-Methyldopa 250mg tab BID PO
taken and BP monitoring done
at home.
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Medical History
Aug. 7-> BP=200/120mmHg &
Plt=58, referred to PGH for
partial HELLP.
VS: BP= 200/120 PR= 112 RR=18
T=37.5 FHT= 140s
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MaNena
PIH (toxemia)
Vasospasm of
small and large
arteries
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PIH
P- Proteinuria
I- Edema
H- Hypertension
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HELLP
A severe form
of PIH
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HELLP
HEmolysis
Elevated Liver
Enzymes
Low Platelet
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CAUSE/ ETIOLOGY:
UNKNOWN
Assoc. with
APAS
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Risk Factors:
Women of >40yo)
color Low
Multiple socioeconomic
Pregnancy Status
Primigravida Poor nutrition
(<20yo or
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Risk Factors:
Multigravida Essential
Heart HPN
diseases Diabetes
Hydramnios
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MaNena
Pathophysiology:

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MaNena
HELLP
HEmolysis
Elevated Liver
Enzymes
Low Platelet
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 Laboratory Values:
Signs Preadmission Preoperative Postoperative
Hemolysis Hgb=142 Hgb=108 Hgb=98->87
Hct= Hct= Hct=
K=3.4 K=4.6

Elevated Liver ALT=16 ALT=29 N

Enzymes AST=76 H
BUN=7.8 H

Low platelet Plt= 58 Plt=74(post 3u PC) Plt=115 (post 5u PC)

Plt=138
Proteinuria Alb +3
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Orthostatic Proteinuria:
On longer periods of
standing, increase CHON in
urine
Collect first urine sample in
AM
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Laboratory Values:
ADDITIONAL PREOP LABS
Hyponatremia- Na=134 L
LDH=1052 H
Alb=31 L
Mg= 1.15 H
Ca= 2.05 L
Crea= 70 N
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MaNena
AUGUST 18, 2019
3PM

SP PRIMARY LSCS UNDER GENERAL

ANESTHESIA
DELIVERED A LIVE BABY BOY, 30
WEEKS BY PEDIATRIC AGING,
WEIGHING 1100 LBS., APPROPRIATE
FOR GESTATIONAL AGE.
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 Medications:
Nicardipine drip- to control BP. 48h
after=resistance
Methyldopa instead of Carvedilol- lactation
issues
Dexamethasone IM/IV-28th-34th week AOG.
Too much will cause fetal brain anomaly.
Hydralazine IV-safe for pregnancy
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 Medications:
Magnesium SIVP,IM, IV- prevents seizure
Tranexamic Acid IV- prevent bleeding
Furosemide-prevent cerebral edema
Amlodipine-safe for lactation
Nifedipine-safe for lactation
Dolcet instead of celecoxib- safe for
kidneys
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 NURSING DIAGNOSES:
INEFFECTIVE TISSUE PERFUSION R/T POOR
DELIVERY OF OXYGEN TO PLACENTA AEB
UTEROPLACENTAL INSUFFICIENCY (CHANGES
IN FHTs)
FLUID VOLUME EXCESS R/T COMPROMISED
REGULATORY MECHANISM AEB BLOOD
PRESSURE CHANGES AND EDEMA
RISK FOR FETOMATERNAL INJURY
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Interventions:
Monitor fetal and maternal well
being.
Monitor vital signs.
Monitor I&O accurately.
Fluid restriction as ordered.
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Interventions:
Administer medications as
ordered.
Bed Rest.
Supplemental Oxygen
Nutrition
Psychological support.
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MAIN GOAL

TERMINATE the
pregnancy

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MAIN GOAL

COMPLETE the
pregnancy

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 THANK YOU!

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