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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?

A

Asthma

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
Q

Why do we prescribe low molecular weight heparin to pre-eclampsia patients?

A

It is prescribed to patients as prophylaxis of venous thromboembolism as a result of their hypertension

26
Q

What are the two actions of magnesium sulphate?

A

Cerebral dilatation

Calcium inhibition

27
Q

When do we prescribe magnesium sulphate to manage pre-eclampsia?

A

It is prescribed during labour and 24 hours post delivery to prevent seizures

28
Q

What is the only definitive management option of pre-eclampsia? When do we select this treatment option?

A

Planned early delivery

In cases where the blood pressure cannot be controlled or complications occur

29
Q

What do we prescribe when pre-eclampsia early delivery is decided in a woman less than 35 weeks’ gestation? Why?

A

IM corticosteroids

To promote development of the fetal lungs

30
Q

What is the postnatal care of pre-eclampsia?

A

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
Q

When does pre-eclampsia resolve?

A

Following delivery of the placenta

32
Q

How do we manage woman who have had previous eclampsia in future pregnancies?

A

They are prescribed aspirin from 12 weeks’ gestation in future pregnancies

This makes sense as this is one of the high risk factors

33
Q

What are the six maternal complications of pre-eclampsia?

A

Eclampsia

HELLP Syndrome

Disseminated Intravascular Coagulation (DIC)

Renal Failure

Heart Failure

Stroke

34
Q

What is eclampsia?

A

It refers to a condition in which hypertension results in tonic clonic seizures during pregnancy

35
Q

What are the two management options of eclampsia?

A

IV Magnesium Sulphate

Anti-Hypertensives

36
Q

What is the first line management option of eclampsia?

A

IV magnesium sulphate

37
Q

What dose of magenisum sulphate is administered to treat eclampsia?

A

IV bolus of 4g over 5-10 minutes

THEN

IV1g / hour

38
Q

Which four investigations are conducted following IV magneisum sulphate?

A

Respiratory rate

Oxygen saturations

Urine output

Reflexes

39
Q

How do we manage respiratory depression as a result of IV magnesium sulphate?

A

Calcium gluconate

40
Q

How long should we continue IV magneisum sulphate treatment for?

A

24 hours > last seizure

24 hours > delivery

41
Q

What is HELLP syndrome?

A

Haemolysis

Elevated Liver enzymes

Low Platelets

42
Q

What is the most appropriate management step in suspected HELLP syndrome?

A

Emergency secondary care admission

43
Q

What clinical feature indicates that an individual is suffering from HELLP syndrome rather than pre-eclampsia?

A

Jaundice

44
Q

What are the three fetal complications of pre-eclampsia?

A

Intrauterine Growth Restrtiction

Hypoxia

Prematurity

Year Three - Reproductive System (52 decks)

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