Pre-eclampsia Flashcards
What happens to BP in normal pregnancy?
There is a reduction in BP during pregnancy due to physiological changes (increased cardiac output due to increased HR and SV paired with reduced vascular resistance)
Define ‘Chronic Hypertension’ in pregnancy
Raised BP before pregnancy or diagnosed hypertension before 20/40
Define ‘Gestational Hypertension’
Raised BP after 20/40 with no systemic features
What is the Pre-Eclampsia (PET) triad?
- HTN (140/90)
- Oedema
- Proteinuria
What is the incidence of PET?
3-5% of pregnancies
List the 5 signs and symptoms of PET
- Headache
- Visual disturbance
- RUQ pain (hepatic ischaemia)
- Reduced urine output
- Lower abdominal pain (placental abruption)
What 4 signs might you see on clinical examination of a patient with PET?
- Pulmonary oedema signs (orthopnoea, dull to percuss, no breath sounds)
- Hepatic tenderness (RUQ)
- Peripheral oedema
- Hyperreflexia
Name at least 2 maternal complications from PET
- Eclampsia (seizure)
- Renal failure
- Pulmonary oedema
- Stroke
List at least 2 foetal complications when a mother has PET
- IUGR
- Placental abruption
- Stillbirth
List the 8 risk factors for PET
- Previous PET
- Primigravida
- FHx of PET
- Pre-existing HTN
- Diabetic
- Obesity (BMI >30)
- Renal disease
- Connective tissue disorder (SLE, EDS)
What is it always important to consider in patients who develop PET?
Is the patient bleeding? Could this be placental abruption?
What investigations should we carry out for the maternal diagnosis?
- FBC - anaemia? Bleeding?
- U&E - renal failure? Systemic problems?
- LFT’s - Hepatic involvement, any ischaemia?
- Urea/creatinine ratio
- Urine dipstick - proteins?
What investigations do we need to carry out to assess foetal wellbeing?
- USS - growth?
2. CTG - foetal HR
What is the ultimate way to control PET?
Deliver the baby safely
What symptoms indicate an immediate delivery of the baby in PET?
- Progressive organ dysfunction of mum
- Inability to control BP with medication
- CTG pathological/worrying
What orchestrates this illness?
Placental dysfunction
How do we treat mothers with PET?
- BP control - Keep the systolic <160 with labetolol, nifedipine or hydralazine to prevent cerebral bleeding
- Fluid balance - restrict fluid due to oedema
- Prevention of eclampsia - Magnesium sulfate infusion
What is HELLP syndrome?
Haemolysis - low Hb
Elevated Liver enzymes - hepatic damage
Low Platelets
What medication is given IV to patients with pre-eclampsia to prevent pregnant women becoming eclamptic?
Magnesium sulfate
