Obstetrics and Gynecology Board Review Pearls of Wisdom

124 Obstetrics and Gynecology Board Review •••

❍ What percentage of eclamptic seizures occur in late postpartum eclampsia (beyond 48 hours postpartum but
<4 weeks)?
25% (attributed to improved prenatal care).

❍ Is fetal bradycardia following a seizure an indication for a stat cesarean?
No. Fetal bradycardia is common after a seizure due to maternal hypoxemia and lactic acidemia. This usually
resolves after 3 to 5 minutes of intrauterine resuscitation. If persistent over 10 minutes, then an imminent delivery
must be considered, as it may indicate other complications such as placental abruption.

❍ What patterns of fetal heart rate may be noted during and after a seizure?
Bradycardia, transient late decelerations, and decreased beat-to-beat variability.

❍ Name the maternal complications that may follow a seizure.
Pulmonary edema, aspiration pneumonitis, cerebral hemorrhage resulting in hemiplegia or sudden death,
blindness, psychosis, placental abruption, DIC, acute renal failure, and cardiopulmonary arrest.

❍ What is the rate of preeclampsia in a subsequent pregnancy after eclampsia in the index pregnancy?
25%.

❍ What is the rate of recurrent eclampsia?
2%.

❍ What are the diagnostic criteria of HELLP syndrome?

Criterion Laboratory findings

Associated Clinical findings

(nondiagnostic)

Hemolysis—

microangiopathic

hemolytic anemia

Abnormal peripheral smear—schistocytes

and burr cells

Elevated indirect bilirubin in the serum

Low serum haptoglobin levels

Elevated LDH (isoforms 1 and 2)

Significant drop in hemoglobin level

Malaise

Elevated liver function

tests

Elevated AST and ALT (usually more than

two times the upper limit of normal)

Abnormal bilirubin levels

Right upper quadrant or epigastric

pain

Nausea

Vomiting

Low platelet count <100,000/mm^3 Mucosal bleeding

Hematuria

Petechial hemorrhages

Ecchymosis