Hypertension in Pregnancy

Question 1

Describe the symptoms and signs of preeclampsia,
as well as the biochemical & haematological
changes that may occur in association with these diagnoses.

Answer 1

Syx: headache, visual changes, photophobia, SOB, abdominal pain (RUQ), swelling (feet, hands, face)

Sx: hyper-reflexia, pitting oedema, elevated BP (>170 sys), proteinuria, oliguria

Biochem/Haem changes:

• headache, visual changes, pitting oedema: cerebral oedema for protein loss
• SOB from pulm oedema
• abdominal pain from liver capsule distension due to liver damage/inflam

Question 2

Describe the symptoms and signs eclampsia,
as well as the biochemical and haematological
changes that may occur in association with these diagnoses

Answer 2

Seizures &/or coma in the presence of PE

Question 3

Outline the current understanding regarding the aetiology and pathophysiology of preeclampsia

Answer 3

Trophoblasts :
errors in placenta formation & invasion –> placental dysfn –> triggers a response (decreased NO, vasc sensitivity etc.) –> systemic dysfn (microthrombi, vasospasm) –> organ dysfn

Question 4

Describe the possible maternal and fetal effects of preeclampsia

Answer 4

Maternal: Neuro (seizures, stroke), Haem (DIC, uncontrolled HT, HELLP), Renal/Liver (failure, liver rupture), Resp (pulmonary oedema, ARDS)

Fetal: IUGR, hypoxia, placental abruption, FDIU

Question 5

Describe the factors which may determine the decision to deliver and timing of delivery in cases of preeclampsia/
eclampsia

Answer 5

Factors

• maternal syx which are imminent of eclampsia / maternal demise –> e.g. increasing proteinuria & BP, face/finger oedema, abdo pain, visual changes/headache, worsening hyper-reflexia
• haemodynamic or respiratory instability mother
• fetal compromise : IUGR, hypoxia
• these all indicate SEVERE PE –> thus need to stabilise & deliver
• mild/moderate syx: admit & monitor, aim to deliver 32-34wks (further preg progresses, worse dx progression)

Timing: only tx for PE is delivery, however not immediate cure

Question 6

Outline the principles of clinical management of preeclampsia/eclampsia

Answer 6

1. MONITOR & STABALISE - BP, UO (oliguria, proteinuria), vitals, neuro exam. Fetal obs (CTG, praevia). ICU transfer for eclampsia & HELLP.
2. PHARMACOLOGICAL - MgSO4 for seizure prophylaxis, Methylodopa/Letbatolol for anti-HT
3. DELIVERY
   a. stabilise mother
   b. vaginal delivery: if fetus >1.5kg, stabile multiparous mum, ripe cervix
   c. CS: IUGR, malpresentation, unripe cervix, primipare

NOTE: eclampsia same as PE, however need supplemental O2

Question 7

Describe the methods available to monitor fetal well-being in cases of preeclampsia/eclampsia

Answer 7

• CTG
• Doppler: MCA, UAW (umbilical a waveform)
• fetal scalp sampling for lactate

Question 8

Outline the postnatal management of the mother with preeclampsia

Answer 8

• needs to be monitored for minimum 24hrs, ideally same number of days she was being treated for HT for antenatally
• monitoring as seizure risk postnatal is still high