Complications of pregnancy 2 (management of PET)

Question 1

How are women at risk of pre-eclampsia managed?

Answer 1

Aspirin 75mg - 12 weeks to birth

BP management - Oral Labetalol*

Tight control of risk factors (DM, SLE etc)

*Labetalol - first line

Nifedipine - if asthmatic etc

Methyldopa

Question 2

A woman has pre-eclamspia and is admitted

What investigations should be done?

(think of features of PET & potential complications to be monitored for)

Answer 2

Frequent BP & urine protein checks

Check symptomatology (headache, visual disturbance, RUQ pain, tenderness over liver)

Check neurology (hyper-reflexia, clonus)

Bloods (typicals, LFTS, RFTs, coags)

Fetal monitoring

Question 3

What bloods should be done for PET?

Answer 3

FBC - esp for haemolysis & platelets

LFTs

RFTs - U&Es, urate

Coagulation tests - if indicated (if above^ indicate HELLP, DIC)

Question 4

What types of fetal monitoring are done in PET?

Answer 4

Scan for growth

CTG

Question 5

What is the only ‘cure’ for pre-eclampsia?

Answer 5

Delivery of the beyblade

Question 6

Give an overview of how we can get delivery of the baby in PET…

Answer 6

Conservative - ie aiming for spontaneous vaginal delivery

Induction of labour or C-section - if condition of mum or bebe is deteriorating

In essence - we can either control the PET and have a relatively normal birth, or get stuck in and delivery the baby if the situation is looking dangerous

Question 7

Describe the conservative approach to acheiving delivery for PET

Answer 7

Close observation - of clinical signs & investigations

Anti-hypertensives - labetalol etc

Steroids (glucocorticoids) - if <36 weeks*

*steroids accellerate lung maturation so are given if pre-term to reduce likelihood of resp distress in the bebe

Question 8

Why is monitoring for PET done postpartum?

Answer 8

Risk of PET persists past birth

a substantial amount of PET happens post birth (44%)

Question 9

How is eclampsia managed?

Answer 9

If seizures or risk of eclampsia*:

• Magnesium sulfate - bolus + IV infusion
• IV Labetalol - or alternative
• Avoid fluid overload - 80mls per hour aim

*risk of eclampsia mainly indicated by neurology signs - hyperreflexia & clonus etc

Question 10

Summarise the management of non-complicated PET…

Answer 10

Immediate management:

• Oral labetolol - or alternative
• Steroids - if <36 weeks
• Monitoring - BP, urine, bloods, neuro, CTG etc
• additional measures if risk of eclampsia etc

Delivery of baby:

• Conservative ideal
• IoL or C-section if condition is deteriorating