🔴 Preeclampsia, Eclampsia & HELLP
A whole-body vascular disease, not a blood pressure number. The three symptoms that mean a seizure is coming, and how magnesium is monitored.
🧬 What is happening
Vessels constrict and leak. Every organ gets less blood, and fluid moves out of the circulation into tissue.
That single mechanism explains everything: the hypertension, the protein in urine, the facial edema, the headache, the liver pain and the seizures.
| Gestational hypertension | Preeclampsia | Severe features | |
|---|---|---|---|
| Blood pressure | ≥140/90 after 20 weeks | ≥140/90 | ≥160/110 |
| Proteinuria | None | Present | Present |
| Other | — | Edema of face and hands | Headache, visual changes, RUQ pain, low platelets, raised creatinine |
Before 20 weeks it is chronic hypertension. After 20 weeks it is gestational. That cut-off is asked directly.
The only cure is delivery of the placenta — everything else buys time.
🚨 The three warning symptoms
These three mean a seizure may be imminent. Report immediately.
Epigastric pain in preeclampsia is not indigestion. It is a late, ominous sign and the patient may seize within hours.
🧠 Eclampsia — when the seizure happens
- Stay with her; call for help
- Turn on her side; protect from injury; do not restrain
- Nothing in the mouth
- Oxygen by mask once the seizure ends; suction as needed
- Note the time and duration; assess fetal heart rate after
- Prepare for delivery once she is stable
🩸 HELLP syndrome
Haemolysis · Elevated Liver enzymes · Low Platelets.
A severe variant — and dangerous because it can occur with only mildly raised blood pressure. Presents with malaise, nausea and RUQ pain.
Do not rule out severe disease because the blood pressure looks acceptable. Check the platelets and liver enzymes.
🩺 Magnesium sulfate
Magnesium prevents seizures. It is not an antihypertensive. That distinction is worth marks on its own — blood pressure is treated separately, usually with labetalol or hydralazine.
Therapeutic range 4–7 mEq/L
🚨 Monitoring, in the order things disappear
| Check | Hold and report if |
|---|---|
| Deep tendon reflexes | Absent — the FIRST warning sign |
| Respiratory rate | <12/min |
| Urine output | <30 mL/hr — magnesium is cleared renally, so it accumulates |
| Level of consciousness | Lethargy, slurred speech |
Antidote: calcium gluconate — kept at the bedside, always.
Reflexes go first. If you check one thing, check the reflexes.
🦹 Environment and care
- Quiet, dim room; minimal stimulation — light and noise can trigger a seizure
- Seizure precautions: padded rails, suction and oxygen at the bedside
- Left lateral position to maximize placental perfusion
- Daily weights; strict input and output; deep tendon reflexes each shift or more often
- Continuous fetal monitoring
🎯 NCLEX traps
- Magnesium prevents seizures, it does not lower blood pressure
- Reflexes are the first thing lost in toxicity
- Calcium gluconate is the antidote
- Facial and hand edema is abnormal; dependent ankle edema is normal
- HELLP can occur with near-normal blood pressure
- The only cure is delivery
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