Gestational hypertension, pre-eclampsia, and eclampsia

Question 1

Define pre-existing hypertension in pregnancy.

Answer 1

• History of HTN before pregnancy or an elevated BP >140/90 mmHg before 20 weeks’ gestation
• No proteinuria, no oedema
• Occurs in 3-5% of pregnancies and is more common in older women

Question 2

Define pregnancy-induced/gestational hypertension.

Answer 2

• Hypertension (>140/90mmHg) occurring in the second half of pregnancy (beyond 20 weeks)
• No proteinuria, no oedema
• Occurs in around 5-7% of pregnancies
• Resolves around 1 month after birth (increased risk of pre-eclampsia or HTN later in life)

Question 3

Define pre-eclampsia.

Answer 3

• Pregnancy-induced HTN in association with proteinuria (>0.3g/24h)
• Oedema may occur
• Occurs in ~5% of pregnancies

Question 4

What are considered to be high risk factors for gestational hypertension/pre-eclampsia?

Answer 4

• HTN during previous pregnancy
• CKD
• Autoimmune disease (SLE or antiphospholipid syndrome)
• T1DM or T2DM
• Chronic HTN

Question 5

What are considered to be moderate risk factors for gestational hypertension/pre-eclampsia?

Answer 5

• First pregnancy
• age >40+
• pregnancy interval of 10+ years
• +ve FHx
• multiple pregnancy

Question 6

What is the management if a woman has 1+ high risk factors or 2+ moderate risk factors for gestational HTN/pre-eclampsia?

Answer 6

75-150mg aspirin from 12 weeks of pregnancy until birth

Question 7

What are the foetal complications of pre-eclampsia?

Answer 7

• Preterm delivery (~10% of all preterm deliveries)
• Stillbirth (~5% of all stillbirths)
• Growth restriction
• Increased risk of placental abruption

Question 8

What are the maternal complications of pre-eclampsia?

Answer 8

• Eclampsia (seizures)
• Haemorrhage
• Liver problems
• Kidney failure
• Pulmonary oedema (fluid in lungs)

Question 9

When do we screen for gestational hypertension/pre-eclampsia?

Answer 9

• Booking visit (8-12 weeks)
• 16 weeks
• 25 weeks (only if primip)
• 28 weeks
• 31 weeks (only if primip)
• 34 weeks
• 36 weeks
• 38 weeks

*If any symptoms indicating pre-eclampsia/HTN

Question 10

What BP indicated urgent admission to hospital?

Answer 10

> /= 160/110

Question 11

What is the management of gestational hypertension/pre-eclampsia?

Answer 11

1st line: labetolol

2nd line/asthmatic: nifedipine

Question 12

How does the presence of gestational hypertension and pre-eclampsia affect mode of delivery?

Answer 12

Gestational hypertension: delivery by 40 weeks

Pre-eclampsia: delivery by 36 weeks in hospital

Question 13

What are the S+S of severe pre-eclampsia?

Answer 13

• Hypertension >160/110
• Proteinuria: dipstick ++/+++
• Headache
• Visual disturbance
• Papilloedema
• RUQ/epigastric pain
• Hyperreflexia
• Platelet count <100*10^6/L, abnormal liver enzymes, HELLP syndrome

Question 14

What is the treatment of eclampsia?

Answer 14

*prevents and treats seizures

• Should be given once a decision to delivery ahs been made
• Give an IV bolus of 4g over 5-10 min followed by an infusion of 1g/hour
• Urine output, reflexes, respiratory rate, and O2 sats should be monitored

Question 15

When is it safe to stop magnesium sulphate infusions?

Answer 15

24h after the last seizure or delivery

Question 16

What is the main adverse effect of magnesium sulphate infusion? How is this reversed?

Answer 16

• Adverse effect: respiratory depression

- Treatment: calcium gluconate