Pregnancy Complication: Recognizing Deviations from the Normal Physiologic Changes in PregnancyLabs

Pregnancy Complication: Recognizing Deviations from the Normal Physiologic Changes in PregnancyLabs

A 27-year-old G2P0010 develops “heartburn” at 30 weeks gestational age. She tries antacids unsuccessfully for 2 days and on the third day experiences severe RUQ pain, a headache, and confusion. On presentation to the labor floor, her blood pressure is 155/90, she is noted to have facial edema and her concentrated urine specimen reveals 2+ proteinuria.

• WBC 18,000 cells/mm³
• Hemoglobin 7.0 g/dL
• Hematocrit 22%
• Platelets 68,000 cells/mm³
• ALT 70 U/L
• AST 64 U/L
• AlkPhos 154 U/L
• LDH 640 mg/dL
• Schistocytes were noted on the peripheral smear

Questions:

1. Elaborate on the scope and standards of an advanced practice registered nurse as applied to the high-risk pregnant patient.
2. Hemolysis, elevated liver functions, and low platelets (HELLP) affects 10% of women with which of the following conditions? Provide rationale and citation(s).
   1. Hepatitis
   2. Hemolytic uremic syndrome
   3. Preeclampsia/eclampsia
   4. Lupus erythematosus
3. Which of the following lab values specifically correlates with HELLP syndrome? Provide rationale and citation(s).
   1. Decreased platelets
   2. Elevated alkaline phosphatase
   3. Increased hematocrit
   4. Decreased BUN
4. When HELLP is diagnosed after 34 weeks, the most appropriate management is? Provide rationale and citation(s).
   1. Corticosteroids for 24 to 48 hours then delivery
   2. Prompt delivery
   3. Expectant management monitoring liver enzymes till 36 weeks
   4. Plasmapheresis then delivery
5. About 25% of women with HELLP syndrome will: (Provide rationale and citation(s).
   1. Experience liver failure
   2. Experience kidney failure
   3. Experience HELLP in a subsequent pregnancy
   4. Die from complications of HELLP
6. Corticosteroid therapy with HELLP syndrome has been shown to: (Provide rationale and citation(s)).
   1. Improve laboratory values
   2. Improve maternal blood pressure
   3. Potentiate the effect of Nifedipine
   4. Decrease the likelihood of HELLP in a subsequent pregnancy
7. Discuss the legal, ethical, socioeconomic, psychosocial, and cultural factors associated with HELLP Syndrome.