DISORDERS OF PREGNANCY AND PARTURITION

Question 1

What is pre-eclampsia?

Answer 1

Condition that causes high blood pressure during pregnancy and after labour

Question 2

What are the symptoms of pre-eclampsia?

Answer 2

New onset hypertension (>= 140/90 mmHg)
Occurring after 20 weeks gestation
Reduced fetal movement (30% of cases)
Reduced amniotic volume (30% of cases)
Oedema common
Headache
Abdominal pain
Visual disturbances, seizures, breathlessness

Question 3

What are the subtypes of pre-eclampsia?

Answer 3

Early onset < 34 weeks:

• fetal + maternal symptoms
• changes in placental structure

Late onset > 34 weeks:

• More common
• Mostly maternal symptoms
• Fetus ok
• Less/no placental changes

Question 4

What are the maternal risk factors for pre-eclampsia?

Answer 4

Previous pregnancy with PE
BMI > 30
Family history
Increased maternal age
Gestational/previous hypertension
Pre-existing conditions e.g. diabetes, PCOS

Question 5

What can pre-eclampsia cause?

Answer 5

Damage to maternal kidneys, liver, brain and other organs
Possible progression to eclampsia (seizures in pregnancy due to high BP)

Placental abruption (placenta separates from endometrium)

Reduced fetal growth, preterm birth, stillbirth

Question 6

Describe the placental defects underpinned PE

Answer 6

Extra-villous trophoblast (EVT) invasion only to decidual layer of endometrium. Thus maternal spiral arteries not extensively remodelled and placental perfusion restricted

Question 7

What chemical signals are associated with the maternal symptoms of PE?

Answer 7

Placental growth factor (PLGF) - pro-angiogenic factor released by placenta
Flt1 (soluble VEGFR1)

Flt1 is a receptor displayed on placental blood vessel endothelium. Binds PLGF. Pre-eclampsia causes excess production of Flt-1 by distressed placenta and thus less available pro-angiogenic PLGF in maternal circulation causing endothelial dysfunction

Question 8

What is the management of pre-eclampsia?

Answer 8

Only resolved by placental delivery

< 35 weeks - try and maintain pregnancy
> 37 weeks - delivery preferable
In between - case by case basis

Anti-hypertensives
Corticosteroids if < 34 weeks to promote fetal lung development

Question 9

What are the prophylactic measures of PE?

Answer 9

Weight loss
Exercise throughout pregnancy
Low-dose aspirin for high risk groups

Question 10

What are the long-term impacts of PE on maternal health?

Answer 10

Elevated CVD risk, T2DM, renal disease

1/8 risk of having pre-eclampsia next pregnancy