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Zero OB + GYN > 8.15 Pre-eclampsia > Flashcards

8.15 Pre-eclampsia Flashcards

1
Q

What features form the triad of pre-eclampsia?

A
  • HTN (>140/>90)
  • proteinuria (ie end organ dysfunction)
  • oedema
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2
Q

What can untreated pre-eclampsia lead to?

A 
Maternal organ damage
FGR
Seizures (eclampsia)
Early labour
and rarely death
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3
Q

At what gestation does pre-eclampsia occur?

A

after 20 weeks (when lacunae are formed)

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4
Q

What part of the blastocyst form chorionic vili? (finger like projections into the endometrium)

A

the syncytiotrophoblast

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5
Q

What does the invading syncytiotrophoblast cause in the endometrium?

A

Signals to the spiral arteries to decrease resistance and become for fragile
–> spiral arteries break down and form lacunae

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6
Q

What pathophysiological happens if the spiral arteries don’t form lacunae properly?

A

This can lead to pre-eclampsia:
–> high vacular resistance in the spiral arteries and poor perfusion of the placenta
–> causes oxidative stress in the placenta and release of inflammatory chemicals
–> leads to systemic inflammation and impaired endothelial function

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7
Q

What are some high-risk factors for pre-eclampsia?

A
  • pre-existing HTN
  • previous HTN in pregnancy
  • autoimmune conditions eg SLE
  • diabetes
  • CKD
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8
Q

What are some moderate-risk factors for pre-eclampsia?

A
  • older than 40
  • BMI >35
  • more than 10 years since previous pregnancy
  • multiple pregnancy
  • first pregnancy
  • FHx pre-eclampsia
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9
Q

What can be given as pre-eclampsia prophylaxis?

A

aspirin

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10
Q

Based on risk factors when is a woman offered aspirin prophylaxis for pre-eclampsia?

A
  • one high-risk factor
  • more than one moderate-risk factor
  • start at 12 weeks
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11
Q

What are the symptoms of pre-eclampsia?

A
  • headache
  • visual disturbance or bluriness
  • nausea and vomiting
  • upper abdo or epigastric pain (liver swelling)
  • oedema
  • reduced urine
  • brisk reflexes
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12
Q

What can be tested in a normal pregnancy to check there isn’t pre-eclampsia?

A

NICE 2019 say test PIGF between 20-30 weeks

PIGF = Placental Growth Factor

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13
Q

What are the NICE diagnostic criteria for pre-eclampsia?

A
  1. BP >140 or >90
  2. PLUS any one of:
    - proteinuria (urine dipstick +)
    - organ dysfunction
    - placental dysfunction (FGR or doppler)
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14
Q

What signs of organ dysfunction can there be in pre-eclampsia?

A
  • raised creatinine
  • elevated liver enzymes
  • seizures
  • thrombocytopenia
  • haemolytic anaemia
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15
Q

How can you quantify the proteinuria in pre-eclampsia?

A
  • urine albumin:creatinine ratio above 30mg/mmol

- urine protein:creatinine ratio above 8mg/mmol

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16
Q

Pre-eclampsia is pregnancy-induced HTN with organ dysfunction, what is gestational hypertension?

A

pregnancy-induced HTN occurring after 20 weeks gestation without proteinuria

17
Q

What is chronic HTN in pregnancy?

A

HTN occurring before 20 weeks (this is not caused bu placenta in anyway)

18
Q

What is eclampsia?

A

When seizures occur due to pre-eclampsia

19
Q

What is the management of gestational HTN?

A
  • treat to aim BP below 135/85
  • admit if BP 160/110
  • minimum weekly urine dipstick
  • weekly bloods (FBC, liver, renal)
  • monitor fetal growth with serial scans
  • PIGF testing once
20
Q

What is 1st line drug for pre-eclampsia?

A

labetalol (beta blocker antihypertensive)

21
Q

What is 2nd line drug for pre-eclampsia?

A

nifedipine (CCB modified release)

22
Q

What is 3rd line drug for pre-eclampsia?

A

methyldopa is 3rd line (stop within 2 days of birth)

23
Q

What 3 things can be used in severe pre-eclampsia?

A
  • hydralazine IV, antihypertensive in critical care in severe pre-eclampsia or eclampsia
  • magnesium sulphate IV during labour and 24 hrs after to prevent seizures
  • fluid restrict during labour in severe pre-eclampsia or eclampsia, to avoid fluid overload
24
Q

Medical treatment choices of pre-eclampsia after delivery?

A

BP will return to normal over time. Meanwhile:

  1. enalapril (1st)
  2. nifedipine or amlodipine (1st in black)
  3. labetalol or atenolol (3rd line)
25
Q

What drug is used to manage seizure in eclampsia?

A

magnesium sulphate IV (stabilises the CNS)

26
Q

What syndrome can occur as a complication of pre-eclampsia or eclampsia?

A

HELLP syndrome

27
Q

What is HELLP syndrome?

A

Haemolysis
Elevated Liver enzymes
Low Platelets

(complication of pre-eclampsia or eclampsia)

28
Q

What complication can result from using magnesium sulphate to control pre eclampsia seizures?

How do you manage the complication?

A

Respiratory depression

Calcium gluconate can be used to manage magnesium sulphate induced resp depression

Zero OB + GYN (86 decks)

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