Assessment of severity

Question 1

Risk factors

Answer 1

High risk

• Chronic HNT or HNT in previous pregnancy
• Autoimmune disease (APL syndrome, SLE)
• Previous severe or early-onset pre-eclampsia
• CKD
• Diabetes mellitus

Moderate risk

• Nulliparity
• FHx of pre-eclampsia (maternal Hx increases risk by 20-25%, sister Hx increases risk by 35-40%)
• Obesity
• New partner with a long interval between previous pregnancy.
• Extremes of maternal age
• Hydatidiform mole, multiparous

Question 2

Pathophysiology

Answer 2

Multisystem disorder originating in placenta. Problem originally stems from failure of trophoblastic invasion of spiral arteries, leaving them vasoactive ( properly invaded they cannot clamp down in response to vasoconstrictors, protecting placental blood flow).
Increasing BP partially compensates for this.

Question 3

Symptoms

Answer 3

May be asymptomatic (esp with mild)
Headache
Visual disturbance
Abdo pain
Swelling of face, hands, feet
?Reduction in foetal movements

Question 4

Signs

Answer 4

HNT
Massive oedema
Proteinuria
Hyperreflexia
Confusion
Abruption
IUGR

Question 5

Ix

Answer 5

Maternal:

• Urine dip (?infection - MSU)
• Protein creatinine ratio (normal = <0.03g/mmol)
• 24hr urine collection
• Bloods (thrombocytopaenia, uric acid elevated, APTT, PT raised, LFT transaminases, anaemia if haemolysis + raised LDH)
• BP monitoring
• Consider urine output/fluid input

Foetal:

• SFH
• CTG
• Growth scan (FGR, oligohydramnios)
• Uterine artery doppler (if growth abnormal)

Question 6

Prevention

Answer 6

Low dose aspirin 75mg

Vitamin D with calcium supplementation

Question 7

Screening tools available?

Answer 7

Early prediction - Uterine artery doppler (not routinely used in UK)
Late prediction - ratio of sFlt-1 to P1GF in maternal blood, esp in women with mild HNT