Disorders of Pregnancy And Parturition

Question 1

Maternal risk factors of PE

Answer 1

Previous PE
BMI >30 especially >35
Family history
Increased maternal age
Gestational hypertension or previous hypertension
Pre-existing conditions - diabetes, PCOS, renal disease, autoimmune
Non-natural cycle IVF

Question 2

Risk of PE to fetus

Answer 2

Reduced growth
Preterm birth
Pregnancy loss/still birth

Question 3

Long term impact of PE on maternal health

Answer 3

Elevated risk of cardiovascular disease, type 2 diabetes and renal disease after PE
Roughly 1/8 risk of having PE in next pregnancy

Question 4

Diagnosis of preeclampsia

Answer 4

New onset hypertension >140 systolic or >90 diastolic
After 20 weeks gestation
Reduced Fetal movement or amniotic fluid volume in 30% cases
Headache ~40%
Abdominal pain ~15%
Visual disturbances, seizures and breathlessness associated with severe PE and risk of eclampsia (seizures)

Question 5

Subtypes of PE

Answer 5

Early onset <34 weeks
-associated with Fetal and maternal symptoms
-changes in placental structure

Late onset >34 weeks
-more common (90%)
-maternal symptoms mostly
-fetus okay
-less overt/no placental change

Question 6

Risks of PE to mother

Answer 6

Damage to kidney, liver, brain and other organ systems
Progression to eclampsia
Placental separation of placenta from endometrium

Question 7

Placental defects of PE

Answer 7

EVT invasion of maternal spiral arteries is limited to decidual layer
Spiral artery not extensively remodelled, thus placental perfusion is restricted

Question 8

PLGF

Answer 8

Placental growth factor
VEGF related, pro-angiogenic factor released in large amounts by placenta

Question 9

Flt1

Answer 9

Soluble VEGFR1
Soluble receptor for VEGF-like factors which bind to soluble angiogenic factors to limit their bioavailability

Question 10

PE and growth factors

Answer 10

Excess production of Flt1 by distressed placenta leads to reduction of available pro-angiogenic factors in maternal circulation, resulting in endothelial dysfunction

Question 11

Predict onset of PE with PLGR

Answer 11

PLGR alone - rule out PE in next 14 days in women 20-36 weeks and 6 days

<12pg/ml - positive, highly abnormal - increased risk of preterm delivery
12-100pg/ml - positive, abnormal - increased risk of preterm delivery
100pg/ml - negative, normal

Question 12

Predict onset of PE with Flt1/PlGR ratio

Answer 12

<38 - rule out pre-eclampsia
>38 - increased risk of pre-eclampsia

Question 13

Management of PE

Answer 13

Only resolved by delivery of placenta

If less than 34 weeks, preferable to try and maintain pregnancy if possible for benefit of fetus
If more than 37 weeks, delivery preferable
In between - case by case

Anti-hypertensive therapies
Corticosteroids for less than 34 weeks to promote Fetal lung development before delivery

Question 14

Prevention of PE

Answer 14

Weight loss
Exercise through pregnancy (independent of BMI)
Low dose aspirin for high risk from 11-14 weeks