104. Pre-eclampsia

Question 1

What is pre-eclampsia?

Answer 1

Hypertenive disorder of pregnancy
Characterised by hypertension and proteinuria developed after 20 weeks
(>140mmHg/90mmHg)- detected on two separate occasions two hours apart

Question 2

What defines severe pre-eclampsia

Answer 2

170mmHg
110mmHg

Demonstrated on two separate occasions

3+ protein dipstick
>1g in 24 hours collection

Question 3

What groups of people get pre-eclampsia

Answer 3

Extremes of maternal age (>40 bad)
Previous PET
multi-parity
Nulliparous women
Insulin dependant diabetes
Chronic hypertension
Renal disease
Heavy BMI

NOT SMOKING!

Question 4

How does pre-eclampsia present?

Answer 4

Usually asymptomatic
Increasing oedema 
Frontal headache
visual distrubrance 
Epigastric pain (triad of fear)

Hyperreflexia
clonus
liver tenderness
confusion

Question 5

What investigations are performed on suspected PET

Answer 5

Regular Blood pressure 
Regular proteinuria assesmsmnet
FBC, LFT, U&E
Platelet, urate, liver enzyme levels
Fetal movements, CTG, measure fundal height

Question 6

How do you treat PET?

Answer 6

Must give antihypertensive in severe pre-eclampsia (stops stroke)

Start anti-hyeprtensives at lower blood pressure if more severe symptoms occur

Fluid restriction (80ml/hour)-

Magnesium sulphate (great for prohlyaxis, eclampsia)

Question 7

What are commonly used anti-hypertensives are used

Answer 7

Libetelol
Methyldopa
Nifedipine

(IV hydralazine, libetelol)

Question 8

What should Oxytocin be used instead of during the third trimester and why

Answer 8

ergometrine and syntometrine

Used to induce contractions

Question 9

What drugs should be used if magnesium sulphate doesn’t work or is contraindicated?

Answer 9

fenotoine, diazepam

Question 10

What is involved when prescribing magnesium sulphate in those with severe PET/eclmapsia

Answer 10

Severe disease- 4g loading dose then 1g per hour for 24 hours after delivery/last seizure

May cause magnesium toxicity

Question 11

What are the symptoms of magnesium toxicity?

Answer 11

Low urine output
Reduction in tendon reflexes
Reduction in respiratory effort

Question 12

What happens to the mother if PET is not treated?

Answer 12

affects almost all organs:
pulmonary oedema, 
renal failure, 
liver failure,
DIC, 
stroke, 
HELLP,
eclampsia

Question 13

What happens to the fetus is PET is not treated?

Answer 13

IUGR

pre-maturity if delivery has to happen ASAP

Question 14

How do you treat IRDS?

Answer 14

Steroids 24-34 weeks to increase surfactant production