Pre-eclampsia Flashcards
What is Pre-eclampsia?
New HTN @ pregnancy w End-organ dysfunction
What is the general Pathophysiology of Pre-eclampsia?
Poor placental perfusion, secondary to abn placentation
How an you understand Pathophysiology of Pre-eclampsia?
Compare normal Placentation vs Pre-eclampsia placentation
What are the steps for Normal placentation? (2 steps)
- Trophoblasts invades Endometrium + Spiral arteries –> Destroys tunica muscularis media
- Spiral arteries dilate –> High flow, low resistance circulation for pregnancy
What are the steps for Normal placentation in Pre-eclampsia? (3 steps)
- Spiral arteries remodelling incomplete –> Low flow, High resistance circulation for pregnancy
- Increase in BP + Hypoxia + Oxidative stress (bc inadeq uteroplacental perfusion)
- Systemic inflamm response + Endothelial cell dysfunction –> leaky blood vessels
What are the titles of RF for Pre-eclampsia? (2 things)
- High RF
- Moderate RF
What are the HIGH RF for Pre-eclampsia? (5 things)
- HTN
- Pre-eclampsia Hx
- AI conditions (e.g SLE)
- DM
- CKD
What are the MODERATE RF for Pre-eclampsia? (5 things)
- Age 40+
- BMI 35+
- 10+ yrs since previous preg
- 1st preg
- Pre-eclampsia FHx
How does number of RF affect Mx of Pre-eclampsia?
- 1+ HIGH RF: Aspirin
- 2+ MODERATE RF: Asprin
When should you offer women w RF Aspirin?
12 wks
What is a simple way to remember CF of Pre-eclampsia? (3 things)
- Proteinuria
- Rise in BP
- Edema
(PRE – eclampsia)
What are the CF Pre-eclampsia? (7 things)
- Headache
- Visual disturbance / blurriness
- N + V
- Brisk reflexes
- Upper abd / epigastric pain (bc liver swelling)
- Oedema
- Reduced urine output
What are the NICE guidelines for Dx of Pre-eclampsia?
BP reading + one Extra CF
What BP readings needed for for Dx of Pre-eclampsia? (2 things
- Systolic 140+
- Diastolic 90+
What are the CF needed for Dx of Pre-eclampsia? (3 things)
- Proteinuria (1+ on dipstick)
- Organ dysf CF
- Placental dysf (e.g foetal growth restriction / abn Doppler)
(only need 1 for Dx)
What CF suggest Organ dysfunction? (5 things)
- Raised creatinine
- Raised liver enzymes
- Seizures
- Thrombocytopaenia
- Haemolytic anaemia
What investigation does NICE recommend for women w sus Pre-eclampsia?
Placental Growth Factor Testing (PlGF) (low in Pre-eclampsia)
What are the Mx options for Gestational HTN (w/o proteinuria, aka NOT Pre-eclampsia)? (5 things)
- Tx n aim for BP below 135/85
- Admit if BP above 160/110
- Weekly bloods + urine dipstick
- Monitor foetal growth (serial growth scans)
- PlGF testing
How do the Mx options change once Pre-eclampsia is Dx? (4 things)
- Same as Gestation HTN plus:
- BP monitor every 48 hrs at least
- Don’t need Dipstick anymore (bc Dx already made)
- US to monitor: Foetus / amniotic fluid / Dopplers (2 weekly)
What are the MEDICAL Mx options for Pre-eclampsia? (6 things)
- Labetolol (anti-HTN) (FIRST LINE)
- Nifedipine (SECOND LINE)
- Methyldopa (THIRD LINE)
- IV hydralazine (SEVERE pre-eclampsia / eclampsia)
- IV Mg sulphate (during labour + 24 hrs after –> to prevent seizures)
- Fluid restriction
What is important to know about Methyldopa as Tx for Pre-eclampsia?
Need to stop it within 2 days of birth
When should you give IV Mg Sulphate in Pre-eclampsia?
- During labour
- 24 hours afterwards
What is the point of giving IV Mg Sulphate in Pre-eclampsia Mx?
Preventing seizures
When should you do Fluid restriction in Pre-eclampsia?
During labour
