Pre-eclampsia

Question 1

Pre-eclampsia

Answer 1

High blood pressure during pregnancy that may be a precursor to a woman developing eclampsia and other complications

Question 2

Pre-eclampsia triad

Answer 2

New-onset HTN

Proteinuria

Oedema

Question 3

Definition

Answer 3

New onset BP >140/90 after 20 weeks of pregnancy and 1 or more of
- proteinuria
- other organ involvement: renal insufficiency, liver, neurological, haematological, uteroplacental dysfunction

Question 4

Potential consequences

Answer 4

Eclampsia

Fetal complications

Liver involvement (elevated transaminases)

Haemorrhage (placental abruption, infra-abdominal, intra-cerebral)

Cardiac failure

Question 5

Features of severe pre-eclampsia

Answer 5

HTN >160/110

Proteinuria

Headache

Visual disturbance

Papilloedema

RUQ/ epigastric pain

Hyperreflexia

Platelet count <100x10^6, abnormal liver enzymes or HELLP syndrome

Question 6

High risk factors

Answer 6

Hypertensive disease in a previous pregnancy

CKD

Autoimmune disease (SLE, antiphospholipid syndrome)

T1/T2DM

Chronic HTN

Question 7

Moderate risk factors

Answer 7

First pregnancy

Age >40

Pregnancy interval >10 years

BMI >35

Family history of pre-eclampsia

Multiple pregnancy

Question 8

Reducing risk

Answer 8

Women with >1 high risk or >2 moderate risk factors

75-150mg aspirin daily from 12 weeks gestation

Question 9

Initial management

Answer 9

Emergency secondary care assessment for any woman in whom pre-eclampsia is suspected

Women with BP?160/110 likely to be admitted

Question 10

Further management

Answer 10

Oral labetalol (nifedipine or hydralazine can be used)

Delivery of baby is most important and definitive management