Pre-eclampsia Flashcards
what
new htn >20wks gestatino with end-organ dysfunction, notably proteinuria
why
spiral arteries of placenta form abnormally leading to high vascular resistance in these vessels
triad
hypertension
proteinuria
oedema
chronic hypertension
htn that exists <20wks gestation and is longstanding
pregnancy-induced/gestational hypertension
htn occurring >20wks gestation w/o proteinuria
eclampsia
seizures occur as result of pre-eclampsia
High-risk factors
pre-existing htn prev gestational htn existing autoimmune condition e.g. SLE diabetes CKD
moderate risk factors
>40yrs BMI >35 >10yrs since last pregnancy multiple pregnancy first pregnancy FHx PET
symptoms
headache blurred vision N&V epigastric pain oedema reduced UO brisk reflexes
diagnosis
>140/>90 plus any of -proteinuria -organ dysfunction -placental dysfunction
quantifying proteinuira
1+ on dipstick
protein: creatinine ratio >30
albumin: creatinine ration >8
organ dysfunction
raised creatinine elevated liver enzymes seizures thrombocytopenia haemolytic anaemia
placental dysfunction
IUGR
abnormal doppler sudies
placental growth factor
protein released by placenta that functions to stimulate development of new blood vessels
in PET levels are low
PET prophylaxis
aspirin
given from 12wks until birth to women with
- single high risk factor
- 2+ moderate risk factors
Mx gestational hypertension
- aim BP < 135/85
- admit if BP >160/110
- wkly urine dipstick
- wkly FBC, LFTs, U&Es
- serial growth scans
- PlGF on one occasion
Mx PET - monitoring
similar to gestation htn also -scoring systems -BP monitored every 48hrs -USS 2wkly
Medical mangement PET
- labetolol
- nifedipine
- methyldopa
IV magnesium sulphate during labour and 24hrs after
fluid restriction
Mx - after delivery
- enapril
- nifedepine or amlodipine (1st line if black african/carribean)
- labaetolol or atenolol
eclampsia
seizures assoc w PET
IV magnesium sulphate
HELLP syndrome
haemolysis
elevated liver enzymes
low platelets
