Pre-eclampsia Flashcards
Define pre-eclampsia
Pregnancy-induced Hypertension in association with proteinuria with or without oedema
New-onset hypertension (BP >140/90) AND new onset proteinuria >30mg/mmol
○ OR other maternal organ dysfunction:
- Renal insufficiency Cr >90 µmol/L
- Liver involvement e.g. elevated ALT, AST ± RUQ pain
- Neurological complications e.g. eclampsia
- Haematological complications e.g. thrombocytopaenia, DIC, or haemolysis
Define eclampsia
Occurrence of one or more convulsions superimposed on pre-eclampsia
What are the parameters of mild/moderate/severe pre-eclampsia and what signifies significant proteinuria
Hypertension
Mild: 140-149/90-99
Moderate: 150/159/100-109
Severe: >160/110
Significant proteinuria likely 2++ on dipstick, of >30mg/nmol PCR
Pre-eclampsia
Mild = mild/moderate HTN
Moderate = severe hypertension with NO complications
Severe pre-eclampsia = presence of any maternal complication
What are the risk factors for pre-eclampsia
Previous pre-eclampsia
Pre-existing HTN
Chronic kidney disease
Pre-existing DM or GDM
Immune disorders e.g. SLE
FHx of pre-eclampsia
Advanced maternal age
What are the top two leading causes of maternal death
- PE
- Pre-eclampsia and eclampsia
What are the symptoms of pre-eclampsia
Presents after 20 weeks
Headache (severe, frontal)
Oedema (SUDDEN swelling of face, hands, feet)
Nausea and vomiting
Epigastric/RUQ pain
Visual disturbance
What are the differentials for pre-eclampsia
Chronic HTN
Gestational HTN
Epilepsy
Antiphospholipid syndrome
TTP
HUS
What are the signs of pre-eclampsia
Obs - hypertension
Fundoscopy - papilloedema
Abdo - RUQ or epigastric tenderness
Resp - assess for pulmonary oedema
Neuro - clonus, hyperreflexia
What investigations are done for pre-eclampsia
Bedside
- Urine dip - proteinuria
- BP - hypertension
Bloods
- FBC: rule out HELLP, may show thrombocytopenia
- LFTs: rule out HELLP
- U&Es
- Renal screen: worsening renal function
- CRP
- Coagulation
- TFTs
Other
- CTG: assess foetal status
- US: assess foetal status
What is the management of first diagnosis of pre-eclampsia
- Confirm pre-eclampsia with urine dip and BP
- Assess need for admission (severe HTN → admit)
- Assess foetal status (CTG and US)
- Insert catheter to monitor fluid input and output
- Consider IV magnesium sulphate to prevent seizures
- Control BP
First: labetalol
Second: nifedipine
Third: methyldopa - US and CTG
- Consider birth timing options
<34 weeks → corticosteroids
What monitoring and foetal assessments do you want to do for a woman with pre-eclampsia
Monitoring
BP - every 48h or 15-30mins (severe)
Bloods - 2x a week or 3x a week (severe)
Foetal assessment
Heart auscultation at every antenatal appointment
US diagnosis then every 2 weeks
CTG and diagnosis then if clinically indicated
What kind of factors will you assess for in a woman with pre-eclampsia when considering admission
- Sustained systolic BP >160mmHg
- Concerning maternal haematological or biochemical investigations
- Signs of impeding pulmonary oedema
- Signs of impending eclampsia
- Suspected foetal compromise
- Any other critical signs that cause concern
What are the birth timing options for a woman with pre-eclampsia
Involve a senior obstetrician
37 weeks or earlier: Consider a planned early birth in women with severe pre-eclampsia
After 37 weeks: initiate birth within 24-48 hours
What medication is given to women with high risk of pre-eclampsia
Low dose aspirin from 12 weeks to birth (75-100mg)
What is the management of eclampsia
Loading dose of 4g, followed by infusion of 1g/hour
Maintain for 24 hours after delivery/last seizure
ECG monitoring during and after 1 hour after loading dose (Magnesium toxicity can lead to PR prolongation)
Calcium gluconate is given in overdose
Monitor RR, O2 sats, deep tendon reflexes
Recurrent seizures - inform anaesthetist and consider diazepam
