Pre-Eclampsia Flashcards
What is pre-eclampsia?
A condition in which new onset hypertension develops during pregnancy, leading to end-organ dysfunction
What is the triad of pre-eclampsia?
New-onset hypertension
Proteinuria
Oedema
When does pre-eclampsia occur?
After 20 weeks of gestation
Describe the pathophysiology of pre-eclampsia
It occurs when the spiral arterioles of the placenta are invaded by trophoblast cells, reducing placental perfusion
There is also an imbalance between vasodilators and vasoconstrictors in pregnancy, leading to a high vascular resistance in these vessels
What are the five high risk factors of pre-eclampsia?
Previous Gestational Hypertension
Chronic Hypertension
Chronic Kidney Disease
Diabetes Mellitus
Autoimmune Diseases
Which two autoimmune conditions are assoicated with pre-eclampsia?
SLE
Antiphospholipid Antibodies
What are the six moderate risk factors of pre-eclampsia?
Nulliparous
Maternal Age > 40
Pregnancy Interval > 10 Years
BMI > 35
Multiple Pregnancy
Pre-Eclampsia Family History
Which patients receive prophylaxis treatment against pre-eclampsia? What treatment is given?
x1 high risk factor
x2 moderate risk factors
It is recommended that women are prescribed 75mg – 150mg aspirin from 12 weeks gestation until birth
What are the six clinical features of pre-eclampsia?
Headache
Visual Disturbances
Papilloedema
Epigastric Pain
Oedema
Hyper-Reflexia With Clonus
What are the three diagnostic criteria of pre-eclampsia?
Gestational Age
AND
Hypertension
AND
Proteinuria OR Other Organ Dysfunction
What gestational age is required for a diagnosis of pre-eclampsia?
20 weeks
What blood pressure readings are required for a diagnosis of pre-eclampsia?
> 140/90mmHg
What blood pressure reading indicates severe pre-eclampsia?
> 160/110mmHg
What proteinuria level is required for a diagnosis of pre-eclampsia?
> 300mg protein in a 24 hour urine sample
OR
ACR level > 30mg/mmol
What is the most appropriate next step in cases where pre-eclampsia is suspected?
Emergency secondary care assessment
What is the most appropriate next step in cases where severe pre-eclampsia is suspected?
Secondary care admission
How do we conservatively treat pre-eclampsia?
It involves monitoring of the maternal and fetal wellbeing
This can be achieved through regular blood pressure measurements every 48 hours, blood tests weekly, fetal growth scans and cardiotocography
What three blood tests are used to conservatively manage pre-eclampsia? Why?
FBC
LFTs
U&Es
This allows us to monitor the function of the kidneys, which are affected by pre-eclampsia, as well as assessing for the development of HELLP syndrome
What are the five pharmacological treatment options for pre-eclampsia?
Labetalol
Nifedipine
Methyldopa
Low Molecular Weight Heparin
Magnesium Sulphate
What is the first line antihypertensive treatment for pre-eclampsia? What class of drug is this?
Labetalol
Beta-blocker
What is a contraindication of labetalol?
Asthma
What is the second line antihypertensive treatment for pre-eclampsia? What class of drug is this?
Nifedipine
Calcium channel blocker
What is the third line antihypertensive treatment for pre-eclampsia? What class of drug is this?
Methyldopa
Alpha-agonist
What is the target blood pressure in pre-eclampsia management?
< 135/80mmHg
Why do we prescribe low molecular weight heparin to pre-eclampsia patients?
It is prescribed to patients as prophylaxis of venous thromboembolism as a result of their hypertension
What are the two actions of magnesium sulphate?
Cerebral dilatation
Calcium inhibition
When do we prescribe magnesium sulphate to manage pre-eclampsia?
It is prescribed during labour and 24 hours post delivery to prevent seizures
What is the only definitive management option of pre-eclampsia? When do we select this treatment option?
Planned early delivery
In cases where the blood pressure cannot be controlled or complications occur
What do we prescribe when pre-eclampsia early delivery is decided in a woman less than 35 weeks’ gestation? Why?
IM corticosteroids
To promote development of the fetal lungs
What is the postnatal care of pre-eclampsia?
We monitor the mother for at least 24 hours post-partum, as they are still risk of having eclamptic seizures
Blood pressure should be monitored regularly up to five days post-partum. The need for antihypertensives should then be reassessed
When does pre-eclampsia resolve?
Following delivery of the placenta
How do we manage woman who have had previous eclampsia in future pregnancies?
They are prescribed aspirin from 12 weeks’ gestation in future pregnancies
This makes sense as this is one of the high risk factors
What are the six maternal complications of pre-eclampsia?
Eclampsia
HELLP Syndrome
Disseminated Intravascular Coagulation (DIC)
Renal Failure
Heart Failure
Stroke
What is eclampsia?
It refers to a condition in which hypertension results in tonic clonic seizures during pregnancy
What are the two management options of eclampsia?
IV Magnesium Sulphate
Anti-Hypertensives
What is the first line management option of eclampsia?
IV magnesium sulphate
What dose of magenisum sulphate is administered to treat eclampsia?
IV bolus of 4g over 5-10 minutes
THEN
IV1g / hour
Which four investigations are conducted following IV magneisum sulphate?
Respiratory rate
Oxygen saturations
Urine output
Reflexes
How do we manage respiratory depression as a result of IV magnesium sulphate?
Calcium gluconate
How long should we continue IV magneisum sulphate treatment for?
24 hours > last seizure
24 hours > delivery
What is HELLP syndrome?
Haemolysis
Elevated Liver enzymes
Low Platelets
What is the most appropriate management step in suspected HELLP syndrome?
Emergency secondary care admission
What clinical feature indicates that an individual is suffering from HELLP syndrome rather than pre-eclampsia?
Jaundice
What are the three fetal complications of pre-eclampsia?
Intrauterine Growth Restrtiction
Hypoxia
Prematurity
