Pre-eclampsia

Question 1

What is pre-eclampsia?

Answer 1

A disorder in pregnancy characterised by:

1. High blood pressure
2. High proteinuria

Question 2

When does pre-eclampsia occur in pregnancy?

Answer 2

After 20 weeks

Question 3

What are the risk factors for pre-eclampsia?

Answer 3

Obesity
Prior HTN
High age
DM

Question 4

How would you diagnose pre-eclampsia?

Answer 4

HTN >140 systolic
Or BP > 90 diastolic on two separate occasions

Proteinuria ≥ 0.3 grams (300 mg) or more of protein in a 24-hour urine sample

Question 5

How can you prevent pre-eclampsia?

Answer 5

Aspirin
Calcium supplementation
Treatment of prior HTN

Question 6

How would you treat pre-eclampsia?

Answer 6

Induce delivery

Antihypertensives such as labetalol, hydralazine and nifedipine

Question 7

Can you give ACE-I in pregnancy?

Answer 7

No, affect fetal development

Question 8

What is the incidence of pre-eclampsia?

Answer 8

2-8% of all pregnancies

Question 9

What are the complications of pre-eclampsia for the mother?

Answer 9

Acutely, pre-eclampsia can be complicated by eclampsia, the development of HELLP syndrome, hemorrhagic or ischemic stroke, liver damage and dysfunction, acute kidney injury, and acute respiratory distress syndrome (ARDS).

Question 10

What are the complications of pre-eclampsia for the baby?

Answer 10

Pre-eclampsia is also associated with increased frequency of Caesarean section, preterm delivery, and placental abruption.

Question 11

What is HELLP syndrome?

Answer 11

HELLP syndrome is defined as hemolysis (microangiopathic), elevated liver enzymes (liver dysfunction), and low platelets (thrombocytopenia). This condition may occur in 10–20% of patients with severe pre-eclampsia and eclampsia

Higher maternal and fetal mortality

Question 12

What is eclampsia?

Answer 12

Eclampsia is the onset of seizures (convulsions) in a woman with pre-eclampsia

The seizures are of the tonic–clonic type and typically last about a minute

Question 13

What are the signs and symptoms of pre-eclampsia?

Answer 13

Pitting oedema

elevated blood pressure and excess protein in the urine

Question 14

What are the signs and symptoms of eclampsia?

Answer 14

Long-lasting (persistent) headaches
Blurred vision
Photophobia (i.e. bright light causes discomfort)
Abdominal pain
Either in the epigastric region (the center of the abdomen above the navel, or belly-button)
And/or in the right upper quadrant of the abdomen (below the right side of the rib cage)

Altered mental status (confusion

Question 15

What are the complications of eclampsia?

Answer 15

Aspiration pneumonia
Cerebral haemorrhage
Kidney failure
Cardiac arrest

Question 16

What are the goals of eclampsia treatment?

Answer 16

he four goals of the treatment of eclampsia are to stop and prevent further convulsions, to control the elevated blood pressure, to deliver the baby as promptly as possible, and to monitor closely for the onset of multi-organ failure.

Question 17

How do you treat convulsions in eclampsia?

Answer 17

Magnesium sulfate

ffective anticonvulsant serum levels range from 2.5 to 7.5 mEq/L

Question 18

What is the cause of pre-eclampsia?

Answer 18

Pre-eclampsia is thought to result from an abnormal placenta, the removal of which ends the disease in most cases

Abnormal development of the placenta leads to poor placental perfusion.

It is thought that this results in oxidative stress, hypoxia, and the release of factors that promote endothelial dysfunction, inflammation, and other possible reactions

The clinical manifestations of pre-eclampsia are associated with general endothelial dysfunction, including vasoconstriction and end-organ ischemia