Management

Question 1

Management of mild pre-eclampsia

Answer 1

BP 140-149/90-99 and urine PCR >30 diagnostic in presence of HNT.
4hrly BP monitoring
Twice weekly bloods to monitor renal function, LFT, FBC
Foetal growth scans every 2w
Twice daily CTG
No need for antiHNT unless BP >150/100.
IOL after 37/40

Question 2

Management of moderate pre-eclampsia

Answer 2

BP 150-159/100-109.
Admit until delivery
Measure BP 4hrly
Bloods three times weekly
Fortnightly foetal growth scans
Twice daily CTG
Start antiHNT
Aim for IOL at 37/40

Question 3

Management of severe pre-eclampsia

Answer 3

BP >160/110 or symptoms/signs or end stage ogan damage.
Get senior help
Stabilise with antiHNT e.g. nifedipine PO twice 30mins apart.
If BP still high, start IV antiHNT (labetalol or hydralazine)
Prophylactic MgSO4 4g loading dose then 1g/hr IV
Bloods every 12-24hr
Maintain strict fluid balance (excess fluids can cause pulmonary oedema), catheterise, give steroids to help foetal lung maturity and if >34/40 deliver
If woman <34w, seek senior advice but typically stabilised then baby delivered within 24-48hrs

Question 4

What is the first line antiHNT used in pregnancy?

Answer 4

Labetalol
Contraindicated in asthma
Risk of IUGR and neonatal hypoglycaemia

Question 5

What is the second line antiHNT used in pregnancy?

Answer 5

Nifedipine
MR form often used to avoid symptomatic hypotension
May cause a sudden drop in BP - affecting uterine perfusion

Question 6

What alternative drug can be given for HNT in pregnancy?

Answer 6

Methyldopa
Slow onset, increases risk of post natal depression if continued postpartum
Not known to harm foetus in any way

Question 7

What is the general principle of managing pre-eclampsia?

Answer 7

Reduce BP and give MgSO4 to prevent seizure; consider delivery

Question 8

How is eclampsia initially managed?

Answer 8

Call for senior help

• support (A-E)
• Control seizures (MgSO4); if loading and continual dose fail give 2g bolus; if still ineffective, treat with IV diazepam and rule out intracranial haemorrhage
• Deliver once mother is stable

Question 9

What is done in eclamptic fit if MgSO4 does not work?

Answer 9

Try diazepam
If RR <12/tendon reflex lost/urine output <20ml/hr then stop Magnesium; have calcium gluconate ready and give 1g over 10 mins if respiratory depression present

Question 10

How is HELLP syndrome treated?

Answer 10

As for eclampsia and delivery is indicated
Regional anaesthesia is contraindicated if plt<80 and if platelets are <50 and surgery is required, cover with platelet transfusion

Question 11

Is there a chance of pre-eclampsia recurring? What is done to prevent this?

Answer 11

10% chance of recurrence in future pregnancies (risk increased if HELLP/early-onset pre-eclampsia in previous pregnancy.
Given prophylactic aspirin (75mg)

Question 12

What is done post-partum in mothers with pre-eclampsia?

Answer 12

Continue blood pressure monitoring for the first few days
Continue antiHNT medication (changing to appropriate meds if necessary) for 6w
Breastfeeding can continue normally (even with preterm infant and being on antihypertensives)