Complications of Pregnancy

Question 1

What is pre-eclampsia?

Answer 1

Pre-eclampsia –> a multisystem disorder characterised by pregnancy-induced hypertension in association with proteinuria, detected after 20 weeks gestation.

Question 2

What is the threshold for hypertension in pregnancy?

Answer 2

Systolic BP ≥ 140mmHg
OR Diastolic BP ≥ 90 mmHg
on two separate occasions, 2 hours apart

Question 3

What is the threshold for severe pre-eclampsia?

Answer 3

Systolic BP ≥ 170mmHg
OR Diastolic BP ≥ 110 mmHg
PLUS protein +++ urine dipstick or 1g/24 hrs on urinalysis (on two separate occasions)
OR signs of end-stage organ failure

Question 4

List some risk factors for pre-eclampsia

Answer 4

Age > 40
Pre-eclampsia in previous pregnancy
Multi-pregnancy
Diabetes
Chronic hypertension
Obesity
Renal disease

Question 5

How may severe pre-eclampsia present?

Answer 5

Frontal headache
Vision disturbance
Epigastric pain
Hyperreflexia and clonus
Liver tenderness
Confusion

Question 6

What investigations should be done in cases of suspected pre-eclampsia?

Answer 6

Blood pressure assessment
24-hour urinalysis
FBC, LFTs, U&Es
Check fetal well-being; movements, USS, measure symphysio-fundal height, fetal CTG

Question 7

Describe how pre-eclampsia should be managed

Answer 7

Administer antihypertensives if BP ≥ 170/110 or if there are signs/symptoms of severe disease
Fluid restriction

Question 8

Give three antihypertensives that are safe to use in pregnancy

Answer 8

Labetalol
Methyldopa
Nifedipine
Hydralazine (IV)

Question 9

What prophylactic treatment should be given to pre-eclamptic women before/during/after labour?

Answer 9

Magnesium sulphate to prevent seizures

• loading dose 4g
• maintenance dose 1g/hr
• continue for 24 hours after delivery or last seizure
• monitor for signs of magnesium toxicity

Question 10

What complications can arise in the mother due to pre-eclampsia

Answer 10

Eclampsia (seizures)
Pulmonary oedema
Renal/Liver failure
Disseminated Intravascular Coagulation (DIC)
Stroke
HELLP syndrome

Question 11

What is HELLP syndrome?

Answer 11

Haemolysis
Elevated Liver enzymes
Low Platelet count

Question 12

What complications can arise in the foetus due to pre-eclampsia?

Answer 12

Intra-uterine growth restriction
Prematurity (foetus must be delivered to cure pre-eclampsia)
- respiratory distress syndrome (RDS)
Placental abruption

Question 13

Which hormones are insulin antagonists?

Answer 13

Glucagon
Cortisol
Human Placental Lactogen
Progesterone
Human Chorionic Gonadotrophin

Question 14

What are the risks of hyperglycaemia in early pregnancy?

Answer 14

Congenital abnormalities:

• cardiac defects
• neural tube defects
• renal abnormalities
• skeletal deformities

Question 15

What are the risks of hyperglycaemia in late pregnancy?

Answer 15

Macrosomia and organomegaly

• increased O2 demand
• risk of dystocia (e.g. shoulder dystocia)
• risk of stillbirth

Question 16

What are the risk factors for gestational diabetes?

Answer 16

Obesity
Previous macrosomic baby ( > 4.5kg)
Previous gestational diabetes
Family history of diabetes
Polyhydramnios or big baby in current pregnancy
Recurrent glycosuria in current pregnancy

Question 17

Which clotting factors are increased in pregnancy? Which are decreased?

Answer 17

Fibrinogen
Prothrombin
Factor VIII
VW factor
Platelets

Decreased endogenous anticoagulants e.g. antithrombin III

Question 18

Which investigations should be done if thromboembolic disease is suspected in a pregnant woman?

Answer 18

Duplex Doppler USS
X-ray/MRI venography if required
CTPA or V/Q scan are useful but beware radiation
ECG and ABH

D-dimer is NOT useful in pregnancy

Question 19

what anticoagulant can be given to pregnant women?

Answer 19

Low molecular weight heparin e.g. enoxaparin