Question

Katie has tox labs drawn to assess for worsening pre-eclampsia. The results are as follows:

• SGOT/AST 44, SGPT/ALT 86, Uric acid 7.7, Creatinine 1.2, Platelets 123K

      DTR’s are 3+ and brisk with 2 beats of clonus. The order reads to start Magnesium sulfate

      with a 4 gram bolus over 30 minutes followed by a continuous infusion at 2grams/hr.   In

      addition, her contractions have diminished and a Pitocin augmentation is initiated at 2

      milliunits/min and to increase q20 minutes until an adequate contraction pattern is attained.

      Her blood pressures range from 131/82 – 156/97.

Questions:

1. What is the significance of Katie’s lab work?

2. What assessment data needs to be collected?

Answer 1

1.Significance of Katie’s lab work:  HELLP SYNDROME

HELLP syndrome is a complication of pregnancy.This is hypertensive disorder of pregnancy.

HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) syndrome is a potentially life-threatening condition manifesting in the context of preeclampsia, which poses challenging diagnostic and management issues to the clinician

HELLP syndrome further classified into HELLP class I,II,III and partial HELLP syndrome by Mississippi triple-class system.

Signs and symptoms:

- Severe epigastric pain or right upper abdominal quadrant pain, accompanied by nausea, vomiting, backache, anaemia, and hypertension

- feeling generally unwell or fatigued

- Some patients may also suffer from a headache and visual issues.

Diagnosis:

- Early and accurate diagnosis, which relies on laboratory tests and imaging exams, is essential for treatment and management and significantly reduces the morbidity rate.

- Blood test -to evaluate platelet,RBC and liver enzymes

- Urine test -to ruleout abnormal protein

- MRI

Treatment:

- blood transfusions to treat anemia and low platelet levels

- magnesium sulfate to prevent seizures

- antihypertensive medication to control blood pressure

   - corticosteroid medication to help your baby’s lungs mature in case an early delivery is needed

2.Assessment Data:

Assessment data between 10 year period( 2005 to 2014) Data were analysed statistically using IBM SPSS 20.0 package (IBM Corp, USA). The distribution for normality was evaluated by the Shapiro–Wilk test. Based on the results, the data was further assessed using the Kruskal–Wallis and Mann–Whitney U-tests (for the non-normally and normally distributed data, respectively). The significance level was set at 5% (p = 0.05).

Further assessment for HELLP syndrome:

Doctor may assess abdominal tenderness, an enlarged liver, and any excess swelling and elevated blood pressure.

The clinical maternal status, gestational age (ultrasound determined), presence of labour and cervical Bishop score should be determined

Fetal assessment test.