PET & Eclampsia Flashcards
outline the triad of PET
- HT >140/90
- Proteinuria
- 1+ on urinalysis
- >0.3g/L
- Oedema
when does it usually occur?
> 20 weeks gestation
what is eclampsia?
grand mal seizures occur as a result of PET
pathophysiology of PET
failure of trophoblast invasion of spiral arterioles causing uteroplacental ischaemia. Associated with
- widespread endothelial dysfunction
- increased maternal inflammatory response
epidemiology?
5-10% of all pregnancies
risk factors?
- High risk
- previous PET
- Pre-existing HT
- chronic health conditions ie CKD, diabetes, auto-immune
- Moderate risk
- age > 40
- BMI > 35
- FH
- first pregnancy
- multiple pregnancy
Symptoms?
- headache
- blurred vision / visual dusturbance
- nausea & vomiting
- epigastric/RUQ pain
- peripheral / papilloedema
severe PET:
- oliguria
- brisk reflexes
- cerebral / pericardial oedema
complications?
- renal / liver failure
- eclampsia
- DIC
- HELLP
- severe HT–> haemorrhage/stroke
- pul oedema
- death
- foetus–> IUGR/foetal distress
outline HELLP syndrome
- Haemolysis
- Elevated Liver enzymes
- Low Platelets
Mx for moderate PET
- <37 weeks- Conservative
- close monitoring & anti-hypertensives
- Curative= delivery (>37 weeks)
- mag sulphate during labour & 24h after
outline choice of anti-hypertensives
- Labetolol
- Nifedipine
how do you monitor the woman closely?
- monitor BP
- monitor urine dipsticks
- monitor symptoms
- do regular bloods: LFT,UE,FBC,Coag
- monitor foetus: CTG / pelvic USS/ umbilical doppler/ foetal movement
Mx of severe PET?
- Anti-hypertensives + Mag Sulphate
- plan urgent delivery
- if <34 weeks, give steroids
- monitor foetus w/ CTG
definition of severe PET
- BP >160/110
- proteinuria 3+
clinically: oliguria, brisk reflexes, cerebral/pericardial oedema
prophylaxis of PET?
if one high risk factor or 2+ moderate risk factors: Aspirin 75mg daily from 12 weeks –> birth
Mx of eclampsia
Mag sulphate IV (bolus + infusion) + IV labetolol
signs of magnesium sulphate OD & Mx
respiratory depression + loss of deep tendon reflexes
Mx–> calcium gluconate
what must you be careful about in severe PET/eclampsia labour?
fluid restriction to avoid fluid overload
