Disorders of Pregnancy and Parturition

Question 1

Where in the world is pre eclampsia more common?

Answer 1

Africa and asia

Question 2

List subtypes of pre eclampsia.

Answer 2

early onset <34 weeks

late onset >34 weeks

Question 3

Early onset pre eclampsia associated with?

Answer 3

foetal and maternal symptoms

changes in placental structure

Question 4

Late onset pre eclampsia associated with?

Answer 4

mostly maternal symptoms, more common, foetus generally okay, less overt/no placental changes

Question 5

diagnosis of pre eclampsia

Answer 5

new onset hypertension, occurring after 20 weeks gestation, reduced foetal movement or amniotic fluid vol, oedema common, headache, abdo pain, visual disturbances, seizures, breathlessness

Question 6

What maternal risk factors pre-dispose to pre-eclampsia?

Answer 6

previous pregnancy with pre-eclampsia, BMI >30, family hx, increased maternal age, gestational/prev. hypertension, diabetes, PCOS, renal disease, subfertility, autoimmunity

Question 7

Risks to the mother (preeclampsia)

Answer 7

damage to kidneys, liver, brain, other organs, possible progression to eclampsia

Question 8

Risks to the foetus (preeclampsia)

Answer 8

placental abruption, reduced fetal growth, pre-term birth, pregnancy loss/stillbirth

Question 9

What structural/developmental changes in the placenta are believed to underpin pre-eclampsia?

Answer 9

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

Question 10

PLGF

Answer 10

VEGF related, pro-angiogenic factor released in large amounts by the placenta.

Question 11

Flt1

Answer 11

Soluble receptor for VEGF-like factors which binds soluble angiogenic factors to limit their bioavailabliltiy.

Question 12

How might soluble Flt1 (aka soluble VEGF1R) and PLFG (aka PlGF) contribute to the maternal symptoms of pre-eclampsia?

Answer 12

excess production of Flt-1 by distressed placenta leads to reduction of available pro-angiogenic factors in maternal circulation, resulting in endothelial dysfuction

Question 13

Can sFlt1a and PlGF be used to predict pre-eclampsia?

Answer 13

either PLGR levels alone (Triage test) or Flt-1/PIGR ratio used to predict onset

Question 14

What management options are available for women who develop PE during pregnancy?

Answer 14

can only be resolved by delivery of the placenta, anti hypertensives and corticosteroids <34 wks for foetal lung dev.

Question 15

Are there preventative measures that can be taken avoid PE developing?

Answer 15

weight loss
exercise throughout pregnancy
low dose aspirin (from 11-14 wks) for high risk

Question 16

Are there any ongoing risks to the mother after pregnancy?

Answer 16

elevated risk of cardiovascular disease, T2DM, renal disease

increased risk of preeclampsia is a sequential pregnancy