Pre-eclampsia

Question 1

What is pre-eclampsia?

Answer 1

Preeclampsia is a hypertensive disorder of pregnancy. It affects 2% to 8% of pregnancies worldwide and causes significant maternal and perinatal morbidity and mortality.

Question 2

Why is PE important?

Answer 2

6th leading cause of direct maternal deaths (6 deaths over 3 years)

Commonest medical problem in pregnancy:

• Gestational hypertension= 10%
• PE= 2-5%
• Severe PE= 1%
• Eclampsia (2% death rate)

Leading cause of iatrogenic prematurity

Immediate risks of eclampsia, stroke and heart failure

Life-long risk of cardiovascular disease

Question 3

High-risk factors

Answer 3

Previous pre-eclampsia
Chronic hypertension
Autoimmune disease
Diabetes Mellitus
Chronic Kidney Disease

Question 4

Moderate-risk factors

Answer 4

Nulliparity
Age>40
Pregnancy interval >10yr
BMI> 35
Family have pre-eclampsia
Multiple pregnancy

Question 5

Moderate-risk factors

Answer 5

Nulliparity
Age>40
Pregnancy interval>10yr
BMI>35
Family hx pre-eclampsia
Multiple pregnancy

Question 6

Pathophysiology

Answer 6

Pre-eclampsia is caused by the placenta; delivery of the placenta is the only known cure. Its manifestations are considered secondary to organ hypoperfusion which arises as a result of vasoconstriction, intravascular coagulation and reduced maternal blood volume.

Question 7

Failure of Normal Placentation

Answer 7

Normal:
- trophoblasts invade maternal vessels
- narrow spiral arteries remodelled
- wide-bore low-resistance vessels deliver large amounts of maternal blood
- nutrient and oxygen delivery to foetus

Question 8

Alternative Hypothesis

Answer 8

MATERNAL HEALTH:
Cerebrovascular morbidity
Chronic kidney disease
Cardiovascular morbidity

PREGNANCY:

Question 9

Common End Pathway

Answer 9

Vasospasm
Endothelial Injury

Question 10

Maternal Effects:

Answer 10

Cerebral oedema: eclampsia
Vasospasm: hypertension, renal failure
Endothelial Injury: low platelets,

Question 11

Current screening and prevention programme:

Answer 11

High-risk factors:
Moderate-risk factors:
Indication for Aspirin:
Aspirin dose
Aspirin duration:

Question 12

Maternal risk factors:

Answer 12

Age: every 10 years above 30y
Weight: every 10kg above 70kg
Racial origin:
- afro-carribean
- south asian
Obstetric history:
- first pregnancy
- previous
Family history of preeclampsia
Conception by IVF
Chronic hypertension
Diabetes

Question 13

Implemetation of aspre at SGH

Answer 13

Two-fold de-escalation of maternal risk (16%

Question 14

No proteinuria

Answer 14

<20/40 (pre-existing HTN)
>20/40 (gestational HTN)

Question 15

Significant proteinuria

Answer 15

Pre-existing HTN secondary to renal disease