Hypertension/Pre-Eclampsia/Eclampsia Management (NICE)

Question 1

What is the acute management of eclamptic seizures?

Answer 1

IV magnesium sulphate

Question 2

What are the symptoms of pre-eclampsia?

Answer 2

Severe headaches
Visual disturbance
Severe pain just below ribs
Vomiting
Sudden swelling of feet, hands or face

Question 3

What women are at high risk for pre-eclampsia?

Answer 3

Hypertensive disease in previous pregnancy
CKD
Autoimmune diseases (lupus, antiphospholipid syndrome)
Diabetes
Chronic hypertension

Question 4

What preventative drug is given to women at high risk of pre-eclampsia and when?

Answer 4

Aspirin (75-150mg)
From 12 weeks until birth

Question 5

What women are at moderate risk of pre-eclampsia?

Answer 5

nulliparity
age 40 years or older
pregnancy interval of more than 10 years
body mass index (BMI) of 35 kg/m2 or more at first visit
family history of pre-eclampsia
multi-fetal pregnancy

Question 6

How many moderate risk factors of pre-eclampsia does someone need to get given prophylactic aspirin?

Answer 6

More than 1

Question 7

First line anti-hypertensive in pregnancy?

Answer 7

Labetalol

Question 8

Second line anti-hypertensive in pregnancy?

Answer 8

Nifedipine

Question 9

Third line anti-hypertensive in pregnancy?

Answer 9

Methyldopa

Question 10

What test can confirm pre-eclampsia and what time frame can this be done?

Answer 10

Placental growth factor (PLGF)-based tests
Between 20 weeks and 36 weeks and 6 days

Question 11

At what blood pressure in a woman with hypertension in pregnancy would you consider an early delivery?

Answer 11

Over 160/110mmHg

Question 12

What helps guide decisions about appropriate place and management in pre-eclampsia?

Answer 12

Risk predictor tools (fullPIERS or PREP-S)

Question 13

What bloods should you regularly monitor in patients with pre-eclampsia?

Answer 13

FBC, liver function and renal function

Question 14

When should you aim to deliver a baby in pre-eclampsia?

Answer 14

37 weeks, doing earlier if clinical indication

Question 15

What risk factors would prompt you to begin prophylactic magnesium sulphate?

Answer 15

ongoing or recurring severe headaches
visual scotomata
nausea or vomiting
epigastric pain
oliguria and severe hypertension
progressive deterioration in laboratory blood tests (such as rising creatinine or liver transaminases, or falling platelet count)

Question 16

How many moderate risk factors does someone need for pre-eclampsia before getting prophylactic aspirin?

Answer 16

2
(1 high risk factor)