12.1 Pre-eclampsia Flashcards
What are the risk factors of pre-eclampsia?
- First pregnancy
- Previous history of pre eclampsia
- BMI >35
- Multiple pregnancy
- >40 years of age
- Pregnancy interval >10 years
- Underlying medical conditions: DM, Renal ds, Hypertension
- Donor eggs/embryo
What are the classifications for someone to have pre-eclampsia?
- Chronic Hypertension
- PIH (Pregnancy-induced hypertension)
- PIH + Proteinuria
- Proteinuria without Hypertension
What is the pathophysiology behind pre-eclampsia?
- Is a multi-system disorder
- Trophoplastic involvement
- Endothelial dysfunction
- Poorly perfused placenta
What is the reccurance risk of pre-eclampsia?
Chances of pre-eclampsia & chronic hypertension = 20-50%
What are the multiple systems affected in pre-eclampsia?
- Neurological e.g.
- Stroke
- Fits
- Hepatic
- Renal
- Oliguria (a decreased urine output)
- Proteinuria
- Haematological
What are the complications of pre-eclampsia (maternal & fetal)?
Maternal
- Seizures
- Pulmonary oedema
- Placental abruption
- CV event
- Stroke
- Death
Fetal
- IUGR (Intrauterine growth restriction refers to poor growth of a fetus while in the mother’s womb)
- Prematurity
- Hypertension
- Stroke
- Demise
What are the signs & symptoms of pre-eclampsia?
SYMPTOMS
- Headache
- Nausea & Vomiting
- Visual disturbances
- Oedema
- Epigastric pain
- Oliguria
SIGNS
- Papilloedema (optic disc swelling that is caused by increased intracranial pressure)
- Clonus (neurological condition that creates involuntary muscle contractions)
- Hyper-reflexia
- Low Platelets
- High Creatinine
- High ALT
- Haemolysis (drop in Hb)
What investigations would you do to diagnose someone with pre-eclampsia?
-
Blood pressure
-
HIGH BP (>140/90)
- Would usually fall in a normal pregnancy
-
HIGH BP (>140/90)
-
Urine analysis
- Could be proteinuria
-
Blood tests
- FBC, clotting factor, LFTs, U&Es
-
Ultrasound
- Check for fetal growth & well-being
- Check maternal uterine blood flow
Explain prevention & prediction of pre-eclampsia?
Prevention
- Primary prevention not possible as cause unknown
- Secondary prevention-observational studies suggest that HEPARIN reduces recurrence in women with thrombophilia (imbalance in clotting factors) & surveillance
- ASPIRIN = risk reduction
PREDICTION
- Angiogenic factor (sFlt-1) from simple urinary test
- PIGF (placental growth factor synthesised by syncytiotrophoblast)
- Ultrasound
What is the pharmacological intervention in pre-eclampsia?
-
Control BP
-
Antihypertensives
- e.g. Labetatol/Hydralazine
-
Antihypertensives
-
Reduce risk of seizure
- Magnesium sulphate
- To benefit fetus
-
Steroid for lung maturation
- E.g. Betamethasone/Dexamethasone
-
Steroid for lung maturation
What is the effect of magnesium on pre-eclampsia?
- Vasodilator
- Neuroprotective
- Excreted by kidneys
- Toxicity
- Antidote
- Calcium gluconate
Explain the management for pre-eclampsia
- MDT involvement
- Fluid restriction
- Observation (BP/pulse/resp rate/urine output/reflexes)
- Bloods, Biochemistry and Urinary protein monitoring
- Drugs (Anti-hypertensives, Magnesium Sulphate, Steroids)
- Fetal monitoring
(Mother takes priority over fetus )
Explain what happens after delivery of the baby & the follow-up (FU)
- VD (vaginal delivery) vs CS (caesarean section) (depends on gestation and severity of condition)
- Continue Mag Sulph for 24 hrs
- Monitor bloods and biochem & BP
- Arrange POST NATAL FU (follow-up)
What are the complications of pre-eclampsia?
ECLAMPSIA (severe)
- Seizures
- Mortality 1:50
- Obstetric Emergency
- Magnesium sulphate IV
- Stabilise mother and deliver
HELLP
Haemolysis
Elevated Liver enzymes
Low Platelets
- Incidence 10-20%
- Results from endothelial damage
- Risk of DIC (Disseminated intravascular coagulation)
- Begins with excessive clotting
