Pre-eclampsia Flashcards
What is pre-eclampsia?
New high blood pressure in pregnancy with end organ dysfunction
What is the triad of pre-eclampsia features?
Hypertension
Oedema
Proteinuria
What is the pathophysiology of pre-eclampsia?
Trophoblast invasion of endometrium sends signals to spiral arteries
Reduced vascular resistance causes increased blood flow to the spiral arteries until they breakdown to cause lacunae
Inadequate lacunae formation = pre-eclampsia
- increased vascular resistance in spiral arteries
- poor placental perfusion
Causes oxidative stress and systemic inflammation
What are moderate risk factors for pre-eclampsia?
>40 years BMI >35 Pregnancy interval >10 years Nulliparity FHx Multiple pregnancy
What are high risk factors for pre-eclampsia?
Pre-existing hypertension Previous hypertension in pregnancy Autoimmune conditions DM CKD
How is pre-eclampsia diagnosed?
BP >140/90 on 2 separate occasions
Proteinuria/organ dysfunction
>20 weeks gestation
What is used for pre-eclampsia prophylaxis?
150mg aspirin
1 high RF
>/=2 moderate RF
What are features of pre-eclampsia?
Often asymptomatic
Headache Visual disturbances N+V Oedema Hyper-reflexia Upper abdominal pain
What causes upper abdo pain in pre-eclampsia?
Liver capsule swelling
How is pre-eclampsia managed?
Weekly urine dip
Regular BP monitoring
Fetal growth scans
Anti-hypertensives
- labetolol
- nifedipine MR
- methyldopa
Planned delivery
What is the mechanism of labetolol?
B-blocker + a-blocker
a-blocker = vasodilation + reduced vascular resistance B-blocker = reduced HR + reduced sympathetic drive
What is the mechanism of nifedipine?
CCB
Reduces myocardial contractility
What is the mechanism of methyldopa?
a-agonist
Reduces TPR
What are maternal complications of pre-eclampsia?
HELLP syndrome
Eclampsia
AKI
DIC
What are fetal complications of pre-eclampsia?
Prematurity
IUGR
Placental abruption
