Pre-eclampsia Flashcards

1
Q

What is pre-eclampsia?

A
  • refers to new high blood pressure (hypertension) in pregnancy with end-organ dysfunction, notably with proteinuria (protein in the urine)
  • occurs after 20 weeks gestation, when the spiral arteries of the placenta form abnormally, leading to a high vascular resistance in these vessels
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2
Q

What can pre-eclampsia lead to without treatment?

A
  • maternal organ damage
  • fetal growth restriction
  • seizures
  • early labour
  • in a small proportion, death
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3
Q

What are the triad of features in pre-eclampsia?

A
  • Hypertension
  • Proteinuria
  • Oedema
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4
Q

What is eclampsia?

A

-when seizures occur as a result of pre-eclampsia

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5
Q

What is the difference between gestational hypertension and pre-eclampsia?

A
  • Pregnancy-induced hypertension or gestational hypertension is hypertension occurring after 20 weeks gestation, without proteinuria.
  • while Pre-eclampsia is pregnancy-induced hypertension associated with organ damage, notably proteinuria.
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6
Q

What are high-risk factors of pre-eclampsia?

A
  • Pre-existing hypertension
  • Previous hypertension in pregnancy
  • Existing autoimmune conditions (e.g. SLE)
  • Diabetes
  • Chronic kidney disease
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7
Q

What are moderate-risk factors of pre-eclampsia?

A
  • Older than 40
  • BMI > 35
  • More than 10 years since previous pregnancy
  • Multiple pregnancy
  • First pregnancy
  • Family history of pre-eclampsia
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8
Q

What do the presence of these risk factors determine?

A
  • used to determine which women are offered aspirin as prophylaxis against pre-eclampsia
  • women are offered aspirin from 12 weeks gestation until birth if they have one high-risk factor or more than one moderate-risk factors
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9
Q

What are the symptoms of pre-eclampsia?

A
  • Headache
  • Visual disturbance or blurriness
  • Nausea and vomiting
  • Upper abdominal or epigastric pain (this is due to liver swelling)
  • Oedema
  • Reduced urine output
  • Brisk reflexes
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10
Q

What is needed for a diagnosis of pre-eclampsia to be made?

A

diagnosis can be made with a:

  • Systolic blood pressure above 140 mmHg
  • Diastolic blood pressure above 90 mmHg

PLUS any of:

  • Proteinuria (1+ or more on urine dipstick)
  • Organ dysfunction (e.g. raised creatinine, elevated liver enzymes, seizures, thrombocytopenia or haemolytic anaemia)
  • Placental dysfunction (e.g. fetal growth restriction or abnormal Doppler studies)
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11
Q

How can proteinuria be quantified?

A
  • Urine protein:creatinine ratio (above 30mg/mmol is significant)
  • Urine albumin:creatinine ratio (above 8mg/mmol is significant)
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12
Q

What is the placental growth factor (PlGF)?

A

Placental growth factor is a protein released by the placenta that functions to stimulate the development of new blood vessels

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13
Q

What are the levels of PlGF in pre-eclampsia?

A
  • the levels of PlGF are low

- NICE recommends using PlGF between 20 and 35 weeks gestation to rule-out pre-eclampsia

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14
Q

What is the initial management for pts at risk of preeclampsia?

A

-Aspirin is used for prophylaxis from 12 weeks gestation until birth to women with 1 high risk factor or more than 1 moderate risk factors

All pregnant women are routinely monitored at every antenatal appointment for evidence of pre-eclampsia, with:

  • Blood pressure
  • Symptoms
  • Urine dipstick for proteinuria
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15
Q

When gestational hypertension (without proteinuria) is identified, what is the general management?

A
  • Treating to aim for a blood pressure below 135/85 mmHg
  • Admission for women with a blood pressure above 160/110 mmHg
  • Urine dipstick testing at least weekly
  • Monitoring of blood tests weekly (full blood count, liver enzymes and renal profile)
  • Monitoring fetal growth by serial growth scans
  • PlGF testing on one occasion
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16
Q

When pre-eclampsia is diagnosed, what is the general management?

A

similar to gestational hypertension, except:

  • Scoring systems are used to determine whether to admit the woman (fullPIERS or PREP‑S)
  • Blood pressure is monitored closely (at least every 48 hours)
  • Urine dipstick testing is not routinely necessary (the diagnosis is already made)
  • Ultrasound monitoring of the fetus, amniotic fluid and dopplers is performed two weekly
17
Q

What is the medical management for pre-eclampsia?

A
  • Labetolol is first-line as an antihypertensive
  • Nifedipine (modified-release) is commonly used second-line
  • Methyldopa is used third-line (needs to be stopped within two days of birth)
  • Intravenous hydralazine may be used as an antihypertensive in critical care in severe pre-eclampsia or eclampsia
  • IV magnesium sulphate is given during labour and in the 24 hours afterwards to prevent seizures
  • Fluid restriction is used during labour in severe pre-eclampsia or eclampsia, to avoid fluid overload
18
Q

If blood pressure cannot be controlled or complications occur what may be necessary in pre-eclampsia?

A
  • planned early birth

- Corticosteroids should be given to women having a premature birth to help mature the fetal lungs

19
Q

What is the management after birth for pre-eclampsia?

A
  • BP is monitored closely after delivery
  • BP will return to normal over time once the placenta is removed

For medical treatment, one or combined of:

  • Enalapril (first-line)
  • Nifedipine or amlodipine (first-line in black African or Caribbean patients)
  • Labetolol or atenolol (third-line)
20
Q

What is used to manage the seizures in eclampsia?

A

IV magnesium sulphate

21
Q

What is HELLP syndrome?

A

HELLP syndrome is a combination of features that occurs as a complication of pre-eclampsia and eclampsia. It is an acronym for the key characteristics:

  • Haemolysis
  • Elevated Liver enzymes
  • Low Platelets