Disorders of Pregnancy Flashcards
Where is pre-eclampsia more common?
Africa and Asia
8-16% of pregnancies
How is pre-eclampsia diagnosed?
During routine check ups:
Check BP
Urine tests
Blood tests
What are the risk factors for pre-eclampsia?
Age
Twin pregnancies
Obesity
First pregnancy
What maternal risk factors may pre-dispose to developing PE?
Age Twin pregnancies Obesity First pregnancy Previous pregnancy with pre-eclampsia Family history Increased maternal age (>40, <20) Gestational hypertension or previous hypertension PCOS Renal disease Diabetes Subfertility Autoimmune disease Non-natural cycle IVF?
What are the risk for mothers post-pregnancy?
4x more likely to develop hypertension
Blood clot
Stroke
2x more likely to develop IHD
What are the risk for mothers during pregnancy?
Damage to kidneys, liver, brain and other organ symptoms
Possible progression to eclampsia
Placental abruption (separation of the placenta from the endometrium)
What are the risk for the foetus during pregnancy?
Reduced foetal growth
Preterm growth
Pregnancy loss/stillbirth
Are there distinct forms of pre-eclampsia?
Early and Late onset
What structural/developmental changes in the placenta are believed to underpin pre-eclampsia?
Normal: EVT invasion of maternal spiral arteries leads to endothelial and smooth muscle breakdown. EVT become endothelial EVT and spiral arteries become high capacity
Ensures nutrient and gas exchange is sufficient
In PE: ECT invasion is limited to decidual layer. Spiral arteries are not remodelled, this placental perfusion is restricted.
How might sFlt1a (soluble VEGF1R) and PLFG (PlGF) contribute to the maternal symptoms of pre-eclampsia?
PLGF: Placental Growth Factor
- VEGF related, pro-angiogenic factor released in large amounts by the placenta
Flt1
- soluble receptor for VEGF-like factors which binds soluble angiogenic factors to limit their bioavailability
Can sFlt1a and PlGF be used to predict pre-eclampsia?
PlGR levels alone or Flt-1/PlGR ration can be used to predict onset of PE
Increased ratio is indicator of increased risk
What management options are available for women who develop PE during pregnancy?
Only resolved by delivery of the placenta
Less than 34 weeks - preferable to try and maintain the pregnancy if possibel for benefit of foetus
Greater than 37 weeks - delivery is preferable
In between - case by case basis
Are there preventative measures that can be taken avoid PE developing?
Anti-hypertensive therapies
Corticosteroids for less than 34 weeks to promote foetal lung development
Are there any ongoing risks to the mother after pregnancy?
Elevated risk of cardiovascular disease, type 2 diabetes and renal disease
Roughly 1/8 risk of having PE in next pregnancy (greater if early onset)
What are the stages of late onset PE?
More common (90%)
Mostly maternal symptoms
Foetus generally OK
Less overt/no placental changes
