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A - MSRA Obstetrics [16] > [18] Pre-eclampsia > Flashcards

[18] Pre-eclampsia Flashcards

1
Q

What is pre-eclampsia?

A

Pregnancy induced hypertension in association with proteinuria (>0.3g in 24 hours)

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2
Q

Why is pre-eclampsia important?

A

It is relatively common but can become life-threatening for mother and fetus

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3
Q

What is severe pre-eclampsia?

A

BP of ≥160/110 mmHg and/or symptoms and/or biochemical and/or haematology impairment

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4
Q

What is eclampsia?

A

The occurence of one or more convulsions superimposed on pre-eclampsia

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5
Q

What % of pregnancies in the UK are affected by pre-eclampsia?

A

6%

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6
Q

How dangerous are severe pre-eclampsia and eclampsia?

A

They are the second most common cause of direct maternal death in the UK

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7
Q

What proportion of pregnancies are affected by severe pre-eclampsia?

A

5/1000

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8
Q

What proportion of pregnancies are affected by eclampsia?

A

5/10,000

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9
Q

What proportion of stillbirths with no congenital abnormalities occur in women with pre-eclampsia?

A

20%

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10
Q

What proportion of women with severe pre-eclampsia deliver before 36 weeks?

A

50%

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11
Q

What is the common thought of what causes pre-eclampsia?

A

Poor placental perfusion due to abnormal placentation

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12
Q

What happens in normal placentation?

A

The trophoblast invades the myometrium and the spiral arteries, destroying the tunica muscularis media, rendering spiral arteries dilated and unable to constrict.

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13
Q

What is the result of normal placentation?

A

Provides pregnancy with a high flow, low resistance circulation

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14
Q

How is the remodelling of spiral arteries different in pre-eclampsia?

A

They are incompletely re-modelled

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15
Q

What is the result of incomplete spiral artery re-modelling in pre-eclampsia?

A

Development of a high resistance, low-flow uteroplacental circulation develops as the constrictive muscular walls of the spiral arterioles is maintained

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16
Q

How does the high resistance, low flow uteroplacental circulationof pre-eclampsia affect BP?

A

Causes an inccrease

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17
Q

What other pathophysiological factors are caused by inadequate uteroplacental perfusion in pre-eclampsia?

A

Hypoxia and oxidative stress

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18
Q

What is caused by the raised BP, hypoxia and oxidative stress caused by pre-eclampsia?

A

Systemic inflammatory response and endothelial cell dysfunction (resulting in leaky blood vessels)

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19
Q

What factors put women at high risk of pre-eclampsia?

A
  • Previous pre-eclampsia
  • Previous eclampsia
  • Previous hypertension in pregnancy
  • Pre-existing hypertension
  • Pre-existing CKD
  • Pre-existing diabetes
  • SLE
  • Antiphospholipid syndrome
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20
Q

What factors put women at moderate risk of pre-eclampsia?

A
  • 10 years or more since last pregnancy
  • First pregnancy
  • Age 40 or more
  • BMI >35 at presentation
  • Family history
  • Multiple pregnancy
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21
Q

What criteria should be met to be diagnosed with pre-eclampsia?

A
  • Hypertension
  • Significant proteinuria
  • > 20 weeks gestation
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22
Q

What is classified as hypertension fulfilling the criteria of pre-eclampsia?

A

BP >140/90 mmHg on 2 occasions >4 hours apart

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23
Q

What is classified as significant proteinuria, fulfilling the criteria of pre-eclampsia?

A

> 300mg protein in a 24 hour urine sample or >30mg/mmol urinary protein:creatinine

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24
Q

Is the presentation of pre-eclampsia the same in everyone?

A

No

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25
Q

Why should proteinuria and hypertension be checked for at every antenatal appointment?

A

Some people with pre-eclampsia are asymptomatic

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26
Q

What are some possible clinical features of pre-eclampsia?

A
  • Headaches
  • Visual disturbance
  • Epigastric pain
  • Sudden onset non-dependent odema
  • Hyper-reflexia
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27
Q

What visual disturbances can occur in pre-eclampsia?

A
  • Blurred or double vision
  • Halos
  • Flashing lights
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28
Q

Where do pre-eclampsia headaches usually occur?

A

Frontal

29
Q

What BP range is mild pre-eclampsia?

A

140-149/90-99 mmHg

30
Q

What BP range is moderate pre-eclampsia?

A

150-159/100-109 mmHg

31
Q

What is severe pre-eclampsia?

A

> 160/100 mmHg AND proteinuria

OR

> 140/90mmHg, proteinuria and symptoms

32
Q

What are the differentials for pre-eclampsia?

A
  • Essential HTN
  • Pregnancy induced HTN
  • Eclampsia
33
Q

What is essential HTN?

A

HTN prior to 20 weeks gestation

34
Q

What is pregnancy induced HTN?

A

New onset HTN after 20 weeks without proteinuria

35
Q

What is eclampsia?

A

Pre-eclampsia and seizures

36
Q

What investigations should be done for pre-eclampsia?

A
  • Urinalysis
  • Blood tests
  • Clotting studies
  • 24 hour urine collection for protein quantification and creatinine clearance
  • Assessment of fetus
37
Q

What analysis should urine undergo in suspected pre-eclampsia if protein is present?

A
  • Microscopy
  • Culture
  • Sensitivty
38
Q

What blood tests should be ordered in assessment of pre-eclampsia?

A
  • FBC
  • LFT
  • Renal function
  • Serum urea
39
Q

How should the fetus be assessed in suspected pre-eclampsia?

A
  • Ultrasound assessment of fetal growth
  • Volume of amniotic fluid
  • Umbilical artery doppler
40
Q

When should a woman with suspected pre-eclampsia be admitted straight to hospital?

A
  • > 1+ protein OR

- >30mg/mmol spot urea:creatinine

41
Q

Whys should women with certain protein or spot protein:creatine be admitted straight to hospital?

A

They are over the dividing line between minimal and significant risk to mother and baby

42
Q

What are the aims of management in pre-eclampsia?

A
  • Prevent development of eclampsia

- Minimise the risk of complications for mother and fetus

43
Q

What plays a large part in management of pre-eclampsia?

A

Monitoring of maternal and fetal wellbeing

44
Q

How can maternal and fetal wellbeing monitoring be achieved in pre-eclampsia?

A
  • Regular BP measurements
  • Urinalysis
  • Blood tests
  • Fetal growth scans
  • Cardiotocography
45
Q

As a rule what is the degree and frequency of monitoring in pre-eclampsia correlated with?

A

Severity of disease

46
Q

What are some other potential management points for pre-eclampsia?

A
  • VTE prevention
  • Anti-hypertensives
  • Delivery
47
Q

Why is VTE prevention an important consideration in the management of pre-eclampsia?

A

Most women are managed as inpatients and require fluid management and VTE prophylaxis

48
Q

What is the most commonly used agent for VTE prevention in pre-eclampsia?

A

LMWH

49
Q

Why are anti-hypertensives used in pre-eclampsia?

A

Reduce the risk of maternal haemorrhagic stroke

50
Q

Do antihypertensives help to alter the course of pre-eclampsia?

A

No

51
Q

What is the only definitive cure for pre-eclampsia?

A

Delivery of the baby

52
Q

What should influence the decision of how and when to deliver in pre-eclampsia?

A

Health of mother and fetus

53
Q

Who does prolonging pregnancy in pre-eclampsia benefit?

A

Only the fetus

54
Q

What should be given if delivery is to occur before 35 weeks gestation for pre-eclampsia?

A

IM steroids

55
Q

Why are IM steroids used for early delivery in pre-eclampsia?

A

to aid development of fetal lungs

56
Q

When does pre-eclampsia resolve?

A

After delivery of the placenta

57
Q

How long should the mother be monitored for post-partum in pre-eclampsia?

A

24 hours

58
Q

Why should the mother have monitoring for 24 hours post-partum in pre-eclampsia?

A

They are still at risk of having eclamptic seizures

59
Q

When can women with pre-eclampsia be considered safe after delivery?

A

Day 5

60
Q

How long should BP be monitored for after delivery in pre-eclampsia?

A

Daily for first 2 days then at least once 3-5 days post-partum

61
Q

Should women stay on anti-hypertensives after pre-eclampsia?

A

The need should be re-assessed

62
Q

What should women be warned of in the future following pre-eclampsia?

A

Risk of developing pre-eclampsia or gestational induced hypertension in future pregnancies

63
Q

What feature of pre-eclampsia is associated with a poorer prognosis for the development of complications?

A

Onset before 34 weeks

64
Q

What are the maternal complications of pre-eclampsia?

A
  • HELLP syndrome
  • Eclampsia
  • AKI
  • DIC
  • ARDS
  • Post-partum hypertension
  • Cerebrovascular damage
65
Q

What are the major fetal complications of pre-eclampsia?

A
  • Prematurity
  • IUGR
  • Placental abruption
  • Intrauterine fetal death
66
Q

How can pre-eclampsia and its complications be prevented?

A
  • Identify women with known risk factors at booking
  • Early recognition and action against symptoms
  • Antiplatelet agents
  • Calcium supplementation in pregnancy
67
Q

What antiplatelet agent is often used to reduce the risk of pre-eclampsia?

A

Low dose aspirin

68
Q

What is NICE’s recommended dose of aspirin for prevention of pre-eclampsia?

A

75mg from 12 weeks to women at high risk or 2 moderate risk factors

A - MSRA Obstetrics [16] (61 decks)

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