Mx - Pre-eclampsia

Question 1

I would suspect pre-eclampsia in a patient presenting with

The patient may have the following risk factors

Answer 1

Maternal sx - headache, blurred vision, oedema, epigastric pain, oliguria
Fetal - decreased fetal movements, FGR, oligohydramnios, abnormal CTG

RFs

• previous history PET or GHTN
• diabetes, obesity, renal disease
• advanced maternal age
• first pregancy, multiple pregancy

Question 2

I would examine for the following signs

Answer 2

General - BP >140/90
Pulmonary oedema
Peripheral oedema
Abdo - epigastric/RUQ tenderness, reduced SFH
CNS - Hyperreflexia, clonus, fundoscopy papilloedema
Urine dipstick - proteinuria

Question 3

I would order the following investigations -

I would obtain IV access and alert my registrar

Answer 3

Urine biochemical analysis of PCR
FBE - Hb and platelets
Liver transaminases and bilirubin
Uric acid and electrolytes

Fetal - Continuous CTG monitoring, USS for growth and wellbeing, amniotic fluid volume and umbilical Doppler study

Question 4

Pre-eclampsia can progress rapidly to complications such as

Answer 4

1) severe hypertension resulting in haemorragic stroke, kidney injury and liver haematoma
2) haemolysis and low platelets causing DIC
3) eclampsia - characterised by presence of seizures
4) fetal distress

Question 5

It is imperative that we admit the patient and initiate immediate treatment with the goals of

Answer 5

1) controlling blood pressure
2) preventing seizures
3) protecting against fetal lung hypoplasia in case premature delivery is required

Question 6

In the case of severe hypertension of 170/110 this patient would require acute BP control with

Answer 6

IV hydralazine - 5mg over 20 minutes, followed by an infusion of 5-10mg per hour.

Question 7

If hypertension is of the order of 140/90 and there is no fetal distress blood pressure can be controlled with

Answer 7

oral methyldopa or labetolol, dosed to control BP within the normal range
If control with one of these agents is unsuccessful, oral hydralazine may be added as a second agent

Question 8

To prevent progression to eclampsia it may be appropriate to administer

Answer 8

IV magnesium sulfate 50% 4g in 8mL over 10 minutes, followed by 2g or 4mL per hour as an infusion.

Question 9

If the gestational age is 24-34 (or even 36) weeks and delivery can be delayed for 24-48 hours I would administer

Answer 9

betamethasone as 2 x 11.4mg IM injections, 24 hours apart to promote fetal lung maturity in case of premature delivery

Question 10

The only cure for pre-eclampsia is delivery of the baby, and so consultant assessment of maternal risk and risks of preterm delivery is needed. The patient may be considered for

Answer 10

induction of labour or caesarian section and I would need to notify the paediatric doctors. I would also notify the anaesthetic doctors and theatre staff in case of caesarian section.

Question 11

In the post-partum period,

Answer 11

women are still at risk of complications of pre-eclampsia, particularly in the first five days, and women should be monitored and antihypertensive treatment continued during this time. In most women the medications can be tapered and ceased as BP returns to pre-pregnancy levels. All women with PET will require follow-up OPD appointment at 6 weeks to ensure blood pressure and urinalysis are normal.