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Year Three - Reproductive System > Pre-Eclampsia > Flashcards

Pre-Eclampsia Flashcards

1
Q

What is pre-eclampsia?

A

A condition in which new onset hypertension develops during pregnancy, leading to end-organ dysfunction

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2
Q

What is the triad of pre-eclampsia?

A

New-onset hypertension

Proteinuria

Oedema

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3
Q

When does pre-eclampsia occur?

A

After 20 weeks of gestation

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4
Q

Describe the pathophysiology of pre-eclampsia

A

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

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5
Q

What are the five high risk factors of pre-eclampsia?

A

Previous Gestational Hypertension

Chronic Hypertension

Chronic Kidney Disease

Diabetes Mellitus

Autoimmune Diseases

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6
Q

Which two autoimmune conditions are assoicated with pre-eclampsia?

A

SLE

Antiphospholipid Antibodies

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7
Q

What are the six moderate risk factors of pre-eclampsia?

A

Nulliparous

Maternal Age > 40

Pregnancy Interval > 10 Years

BMI > 35

Multiple Pregnancy

Pre-Eclampsia Family History

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8
Q

Which patients receive prophylaxis treatment against pre-eclampsia? What treatment is given?

A

x1 high risk factor

x2 moderate risk factors

It is recommended that women are prescribed 75mg – 150mg aspirin from 12 weeks gestation until birth

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9
Q

What are the six clinical features of pre-eclampsia?

A

Headache

Visual Disturbances

Papilloedema

Epigastric Pain

Oedema

Hyper-Reflexia With Clonus

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10
Q

What are the three diagnostic criteria of pre-eclampsia?

A

Gestational Age

AND

Hypertension

AND

Proteinuria OR Other Organ Dysfunction

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11
Q

What gestational age is required for a diagnosis of pre-eclampsia?

A

20 weeks

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12
Q

What blood pressure readings are required for a diagnosis of pre-eclampsia?

A

> 140/90mmHg

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13
Q

What blood pressure reading indicates severe pre-eclampsia?

A

> 160/110mmHg

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14
Q

What proteinuria level is required for a diagnosis of pre-eclampsia?

A

> 300mg protein in a 24 hour urine sample

OR

ACR level > 30mg/mmol

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15
Q

What is the most appropriate next step in cases where pre-eclampsia is suspected?

A

Emergency secondary care assessment

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16
Q

What is the most appropriate next step in cases where severe pre-eclampsia is suspected?

A

Secondary care admission

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17
Q

How do we conservatively treat pre-eclampsia?

A

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

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18
Q

What three blood tests are used to conservatively manage pre-eclampsia? Why?

A

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

19
Q

What are the five pharmacological treatment options for pre-eclampsia?

A

Labetalol

Nifedipine

Methyldopa

Low Molecular Weight Heparin

Magnesium Sulphate

20
Q

What is the first line antihypertensive treatment for pre-eclampsia? What class of drug is this?

A

Labetalol

Beta-blocker

21
Q

What is a contraindication of labetalol?

22
Q

What is the second line antihypertensive treatment for pre-eclampsia? What class of drug is this?

A

Nifedipine

Calcium channel blocker

23
Q

What is the third line antihypertensive treatment for pre-eclampsia? What class of drug is this?

A

Methyldopa

Alpha-agonist

24
Q

What is the target blood pressure in pre-eclampsia management?

A

< 135/80mmHg

25
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
26
What are the two actions of magnesium sulphate?
Cerebral dilatation Calcium inhibition
27
When do we prescribe magnesium sulphate to manage pre-eclampsia?
It is prescribed during labour and 24 hours post delivery to prevent seizures
28
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
29
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
30
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
31
When does pre-eclampsia resolve?
Following delivery of the placenta
32
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
33
What are the six maternal complications of pre-eclampsia?
Eclampsia HELLP Syndrome Disseminated Intravascular Coagulation (DIC) Renal Failure Heart Failure Stroke
34
What is eclampsia?
It refers to a condition in which hypertension results in tonic clonic seizures during pregnancy
35
What are the two management options of eclampsia?
IV Magnesium Sulphate Anti-Hypertensives
36
What is the first line management option of eclampsia?
IV magnesium sulphate
37
What dose of magenisum sulphate is administered to treat eclampsia?
IV bolus of 4g over 5-10 minutes THEN IV1g / hour
38
Which four investigations are conducted following IV magneisum sulphate?
Respiratory rate Oxygen saturations Urine output Reflexes
39
How do we manage respiratory depression as a result of IV magnesium sulphate?
Calcium gluconate
40
How long should we continue IV magneisum sulphate treatment for?
24 hours > last seizure 24 hours > delivery
41
What is HELLP syndrome?
Haemolysis Elevated Liver enzymes Low Platelets
42
What is the most appropriate management step in suspected HELLP syndrome?
Emergency secondary care admission
43
What clinical feature indicates that an individual is suffering from HELLP syndrome rather than pre-eclampsia?
Jaundice
44
What are the three fetal complications of pre-eclampsia?
Intrauterine Growth Restrtiction Hypoxia Prematurity

Year Three - Reproductive System (52 decks)

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