Pre-Eclampsia Flashcards

1
Q

what is pre-eclampsia

A

onset of new hypertension that occurs after 20 weeks with significant proteinuria

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2
Q

biggest risk factor for pre-eclampsia

A

gestational hypertension

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3
Q

what monitoring is done if a women is diagnosed with hypertension

A
blood pressure
blood profile 
urinalysis
fetal movements
CTG if appropriate
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4
Q

when do you give pregnant women antihypertensives

A

systolic BP >150

diastolic BP >100

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5
Q

1st line anti-hypertensive in pregnancy

A

oral labetalol

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6
Q

2nd line anti-hypertensive in pregnancy

A

nifedipine

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7
Q

what antihypertensives are contraindicated in pregnancy

A

ACEis
ARBs
chlorothiazide

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8
Q

when do you diagnose pre-eclampsia

A

BP >140/90 with

significant proteinuria

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9
Q

how do you treat pre-eclampsia

A
admit 
BP - 6 hourly 
bloods - 2-3x per week
fetal movement
CTG
US for amniotic fluid index 
doppler flow studies
USS of fetal growth
fluid balance management
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10
Q

how do you manage fluid balance in pre-eclampsia

A

limit fluid intake to 80ml/hour

monitor urine output aiming for >30ml/hr

if fluid output <30ml/hr consider 250ml fluid challenge

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11
Q

when do you give the mother corticosteroids

A

if <36 weeks and looks like shes going to delivery

prevents RDS in newborn

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12
Q

maternal indications to expedite birth

A
eclampsia
uncontrollable severe hypertension 
persistent neuro symptoms
persistent epigastric pain
low platelets
abnormal LFTs/renal function
pulmonary oedema
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13
Q

fetal indications to expedite birth

A
abnormal/non-reassuring heart rate
severe fetal growth restriction
absent or reverse arterial doppler flow studies
AFI <5
placenta abruption
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14
Q

how do you define hypertension in pregnancy

A

systolic >140

diastolic >90

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15
Q

what is mild hypertension in pregnancy

A

140/90 - 149/99

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16
Q

what is moderate hypertension in pregnancy

A

150/100 - 159/109

17
Q

what is severe hypertension in pregnancy

A

> 160/110

18
Q

what is severe pre-eclampsia

A

pre-eclampsia with severe hypertension

19
Q

risk factors for pre-eclampsia

A
previous episode
FH
chronic hypertension 
diabetes
>10 years between pregnancies
nulliparity or primiparity 
age >40
gestational hypertension 
BMI>35
multiple pregnancy 
previous IUD
fetal triploidy
20
Q

which organ systems are effected by pre-eclampsia

A
neuro
haematological
hepatic
renal 
placental
21
Q

neurological presentation of pre-eclampsia

A
severe headache
visual disturbances
hyperreflexia and sustained clonus
seizures (eclampsia)
stroke
22
Q

haematological complications of pre-eclampsia

A

thrombocytopenia
haemolytic
DIC

23
Q

liver involvement in pre-eclampsia

A

epigastric pain
right upper quadrant pain
abnormal LFTs

24
Q

renal involvement in pre-eclampsia

A

proteinuria
oliguria <30mls per hour
elevated serum creatinine

do urinalysis, protein:creatinine ration and 24 hour urine collection

25
Q

what happens to the fetus in pre-eclampsia

A

affects blood flow to placenta causing:

  • decreased fetal movements
  • IUGR
  • Abnormal or non-reassuring fetal heart

do a CTG every time a pre-eclamptic women feels reduced movement, abdominal pain or bleeding or weekly

26
Q

US presentation of IUGR

A

asymmetrical intrauterine fetal growth

lower amniotic fluid index (concern when <5)

umbilical artery flow - increased resistance to flow

27
Q

what are abnormal features on CTG

A

absent accelerations

decreased baseline variability

shallow decelerations

28
Q

what is eclampsia

A

occurrence of one or more seizures superimposed on pre-eclampsia

29
Q

when does eclampsia occur

A

38% antenatal
18% intrapartum
44% postpartum

30
Q

other causes of seizure in pregnancy

A
epilepsy
meningitis
SOL
hypertensive encephalopathy 
hypoglycaemia
drug overdose
31
Q

how to manage eclamptic seizure

A

call for help 2222
ABCDE

roll women onto left side to improve placental blood flow

maintain airway - give high flow oxygen 15L

32
Q

what medication is used to treat eclamptic seizures

A

magnesium sulphate

loading does of 4g administered IV over 5 mins

maintenance dose of 1g per hour for 24 hours

if seizures re-occur give a further 2-4g IV over 5 mins

33
Q

second line medication for eclamptic seizures

A

IV diazepam

clonazepam

34
Q

signs of magnesium sulphate toxicity

A
urine <100ml in 4 hours
absent deep tendon reflexes
RR <10
elevated MgSO4 levels
slurred speech
cardiac arrest
35
Q

can you continue pregnancy with pre-eclampsia

A

no - need to be stabilised and give birth

make sure to give labetalol to lower BP before birth