9) Pre-eclampsia and eclampsia - diagnosis, CF's + Management

Question 1

What is the definition of '’Preeclampsia”?

Answer 1

• New Onset Hypertension with Proteinuria
• Occurs AFTER 20th Gestational Week

Question 2

What is the Cause of Preeclampsia?

Answer 2

• Due to POOR Placental Perfusion
• Either from Abnormal Placenta
• or Incomplete remodelling of SPIRAL Arteries

Question 3

What are the Systemic Effects of Preeclampsia?

Answer 3

• KIDNEY = Lead to Glomerular Endothelial Dysfunction and HTN-induced vasoconstriction
• LIVER = Leads to Vasoconstriction and Micro-thrombotic Obstruction of SINUSOIDS, thereby resulting in Hepatocyte Damage
• CNS = Leads to HTN-induced vasoconstriction, which can disrupt cerebral circulation
• Blood = Leads to Vasoconstriction, resulting in an Overactive Coagulation System + Platelet Consumption –> causing DIC

Question 4

What are the Types of Preeclampsia?

Answer 4

1) MILD = BP is MORE than 90/140 mmHg; along with Proteinuria MORE than 3g / 2h; characterised w/ headaches, Epigastric Pain + visual changes

2) SEVERE = BP is MORE than 110/160 mmHg; along with Proteinuria MORE than 5g / 2h; characterised w/ blurred vision, pulmonary oedema, RUQ pain, clonus, hyperreflexia

Question 5

What are the Risk Factors for Preeclampsia?

Answer 5

• Nullparity (New)
• Older than 40 y/o
• Chronic HTN
• Multiple Pregnancies
• Chronic Renal Disease
• AIDS / HIV
• DM

NB! = IF these RFs are present, from 12th Gestational Week give 75mg Aspirin

Question 6

What are the (Maternal & Fetal) Complications of Pre-eclampsia?

Answer 6

MATERNAL = HELLP Syndrome

• H = Hemolysis
• EL = Elevated Liver Enzymes
• LP = Low Platelet Count
• Eclampsia, Placental Abruption,DIC, Pulmonary Oedema

FETAL = Prematurity, Intrauterine Growth Restriction (IUGR), and Hypoxia

Question 7

How is Preeclampsia Diagnosed?

Answer 7

• Monitoring of Blood Pressure
• Using the Uterine Artery Pulsatile Index, Placental Growth Factor
• Urine Analysis = 24h Urine Collection

Question 8

What is the Treatment for Preeclampsia?

Answer 8

• Anti-Hypertensives = Nifedipine, Methyldopa + Hydralazine

NB! DEFINITIVE Treatment = Delivery only

• Prophylaxis = Magnesium Sulfate MgS04
• IF 24 - 34 Weeks (Premature) = Give Corticosteroids for maturation of FETAL LUNG

Question 9

What are the Indications for IMMEDIATE Delivery?

Answer 9

• Eclampsia, Pulmonary Oedema, DIC, Placental Disruption, Fetal Demise

AFTER Corticosteroids –> Premature Rupturing of Membrane, Oligohydraminos, or Abnormal LFTs

Question 10

What is the definition of '’Eclampsia”?

Answer 10

• Severe FORM of Preeclampsia, which is life-threatening
• Along with Generalised Tonic-Clonic Seizures

Question 11

What are the Risk Factors for Eclampsia?

Answer 11

• Nullparity (NEW)
• Pre-existing Vascular Diseases
• Multiple Pregnancies
• Race, Age
• Family Hx
• Smoking

Question 12

What are the Complications for Eclampsia?

Answer 12

• Hemorrhagic Stroke
• Death!

Question 13

What is the Treatment for Eclampsia?

Answer 13

• Anti-convulsants = For the seizures aka DIAZEPAM

NB! DEFINITIVE Treatment = Delivery only