Pre-eclampsia

Question 1

What is pre-eclampsia?

Answer 1

BP >140/90 after 20 weeks gestation with proteinuria (end-organ dysfunction)

Triad of:

• HTN
• Proteinuria
• Oedema

Diagnostic criteria:
- HTN plus one or more of:

• Proteinuria: 1+ or more on dipstick or a urine protein/creatinine ratio ≥30 mg/mmol
• Organ dysfunction e.g. liver involvement, renal insufficiency, DIC
• Uteroplacental dysfunction e.g. intrauterine growth restriction

Question 2

Pathophysiology of pre-eclampsia

Answer 2

Abnormal trophoblast invasion in the first trimester

Underdeveloped spiral arteries - failure to transform in to low resistance vessels

Leading to poorly perfused placenta

Question 3

Risk factors for pre-eclampsia

Answer 3

High-risk factors:

• Pre-existing HTN
• Previous HTN in pregnancy
• DM,CKD, Autoimmune conditions,

Moderate risk factors:

• Over >40
• BMI >35
• Multiple pregnancy
• First pregnancy
• Family history of pre-eclampsia
• More than 10 years since previous pregnancy

Question 4

When give prophylaxis for pre-eclampsia and what?

Answer 4

Aspirin from 12 weeks in high risk women

if have one high risk factor or more than one moderate risk factor

Question 5

Complications of pre-eclampsia

Answer 5

Maternal - HELLP syndrome, eclampsia (seizures), intracranial haemorrhage

Foetal:

• Placental abruption
• IUGR

Question 6

Symptoms of pre-eclampsia

Answer 6

Headache
Visual disturbance
N+V
Abdominal pain - RUQ 
Oedema
Brisk reflexes

Question 7

Investigations in pre-eclampsia

Answer 7

Urine dip - for protein (can also quantify proteinuria using urine protein:creatinine ratio)

BP

Bloods - LFTs (looking for elevated liver enzymes as in HELLP)

• FBC (for Hb - low in haemolytic anaemia and for platelets e.g. thrombocytopaenia in HELLP),
• U+Es (may have raised creatinine indicated organ dysfunction)
• Clotting

Question 8

Management of pre-eclampsia

Answer 8

Labetalol is first line
Nifedipine is second line
Methyldopa is third line

Definitive treatment is delivery:

• <34 weeks - C/S
• > 34 weeks can consider vaginal delivery - aim for short second stage labour, 3rd stage should be managed with IV oxytocin

Planned early birth may be necessary if the blood pressure cannot be controlled or complications occur. Corticosteroids should be given to women having a premature birth to help mature the fetal lungs.

Question 9

When does BP return to normal?

Answer 9

Should return to normal over a few weeks after the placenta is removed

Should monitor BP closely after to delivery and switch to enalapril until BP is normal

Question 10

Treatment of Eclampsia

Answer 10

IV magnesium sulphate
CTG monitoring -
Likely to need early delivery

Question 11

HELLP syndrome treatment

Answer 11

IV magnesium sulphate (to prevent seizures)
Antihypertensives
Timely delivery to reduce disease progression
Corticosteroids to mature baby’s lungs