Pre-Eclampsia Flashcards
what is pre-eclampsia
onset of new hypertension that occurs after 20 weeks with significant proteinuria
biggest risk factor for pre-eclampsia
gestational hypertension
what monitoring is done if a women is diagnosed with hypertension
blood pressure blood profile urinalysis fetal movements CTG if appropriate
when do you give pregnant women antihypertensives
systolic BP >150
diastolic BP >100
1st line anti-hypertensive in pregnancy
oral labetalol
2nd line anti-hypertensive in pregnancy
nifedipine
what antihypertensives are contraindicated in pregnancy
ACEis
ARBs
chlorothiazide
when do you diagnose pre-eclampsia
BP >140/90 with
significant proteinuria
how do you treat pre-eclampsia
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
how do you manage fluid balance in pre-eclampsia
limit fluid intake to 80ml/hour
monitor urine output aiming for >30ml/hr
if fluid output <30ml/hr consider 250ml fluid challenge
when do you give the mother corticosteroids
if <36 weeks and looks like shes going to delivery
prevents RDS in newborn
maternal indications to expedite birth
eclampsia uncontrollable severe hypertension persistent neuro symptoms persistent epigastric pain low platelets abnormal LFTs/renal function pulmonary oedema
fetal indications to expedite birth
abnormal/non-reassuring heart rate severe fetal growth restriction absent or reverse arterial doppler flow studies AFI <5 placenta abruption
how do you define hypertension in pregnancy
systolic >140
diastolic >90
what is mild hypertension in pregnancy
140/90 - 149/99
what is moderate hypertension in pregnancy
150/100 - 159/109
what is severe hypertension in pregnancy
> 160/110
what is severe pre-eclampsia
pre-eclampsia with severe hypertension
risk factors for pre-eclampsia
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
which organ systems are effected by pre-eclampsia
neuro haematological hepatic renal placental
neurological presentation of pre-eclampsia
severe headache visual disturbances hyperreflexia and sustained clonus seizures (eclampsia) stroke
haematological complications of pre-eclampsia
thrombocytopenia
haemolytic
DIC
liver involvement in pre-eclampsia
epigastric pain
right upper quadrant pain
abnormal LFTs
renal involvement in pre-eclampsia
proteinuria
oliguria <30mls per hour
elevated serum creatinine
do urinalysis, protein:creatinine ration and 24 hour urine collection
