pre-eclampsia Flashcards
1
Q
what are the risk factors for pre-eclampsia?
A
- maternal age > 40 years
- maternal BMI > 30
- family history
- parity (more likely in first pregnancy)
- multiple pregnancy
- previous PE
- birth interval > 10 years
- molar pregnancy/triploidy
- multiparous women develop more severe disease
- pre-existing conditions i.e. renal disease, hypertension, DM, CTD, thrombophilias
2
Q
describe the pathophysiology of pre-eclampsia?
A
- diffuse vascular endothelial dysfunction w widespread circulatory disturbance
- classified as early or late
early: <34 weeks, uncommon, assoc w placental dysfunction
late: >34 weeks, accounts for 9/10 cases
stage 1: abnormal placental perfusion (placental ischaemia)
stage 2: maternal syndrome (anti-angiogenic state assoc w endothelial dysfunction)
3
Q
what kind of liver disease can predispose a women to pre-eclampsia?
A
- HELLP syndrome
: haemolysis, elevated liver enzymes, low platelets
> abnormal liver enzymes
hepatic capsule rupture
4
Q
how does placental disease affect baby?
A
- fetal growth restriction
- placental abruption
- intrauterine death
5
Q
what is the clinical presentation of pre-eclampsia
A
- hypertension
- proteinuria
- oedema
> however women may be asymptomatic at the time of their first presentation
6
Q
what are some symptoms of pre-eclampsia?
A
- headache
- visual disturbance
- epigastric/RUQ pain
- nausea and vomiting
- rapidly progressive oedema
7
Q
what are some signs of pre-eclampsia?
A
- hypertension
- proteinuria
- oedema
- abdominal tenderness
- disorientation
- hyper-reflexia/involuntary movements/clonus
- SGA fetus
- intra-uterine fetal death
8
Q
what investigations are carried out for pre-eclampsia?
A
bloods: U+Es, serum urate, LFTs, FBC, coag screen
urine: protein:creatinine ratio
CTG
US - fetal assessment
9
Q
what is the mx for pre-eclampsia?
A
- low dose aspirin 150mg - may more beneficial in preventing severe early onset pre-eclampsia
> used for high risk women
> safe in pregnancy
> commence before 16 weeks - only ‘cure’ for pre-eclampsia is birth
mother must be stabilised before birth
consider expectant mx if pre-term
steroids/magnesium sulphate
most women delivered within 2 weeks of dx
10
Q
what are complications of pre-eclampsia?
A
- eclampsia
- HELLP syndrome - haemolysis, elevated liver enzymes and low platelets
- pulmonary oedema
- placental eruption
- cerebral haemorrhage
- cortical blindness
- disseminated intravascular coagulation (DIC)
- acute renal failure
- hepatic rupture