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Y4 - GOSH > Pre-eclampsia > Flashcards

Pre-eclampsia Flashcards

1
Q

What is the definition of pre-eclampsia?

A
  • new hypertension in pregnancy with end-organ dysfunction
  • it most notably presents with proteinuria
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2
Q

When does pre-eclampsia typically present?

A

after 20 weeks gestation

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3
Q

Why is it important to recognise and treat pre-eclampsia?

A

without treatment it can result in:

  • seizures
  • early labour
  • intrauterine growth restriction
  • maternal organ damage
  • death
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3
Q

Why is it important to recognise and treat pre-eclampsia?

A

without treatment it can result in:

  • seizures
  • early labour
  • intrauterine growth restriction
  • maternal organ damage
  • death
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4
Q

What is the classic triad of pre-eclampsia?

A
  1. hypertension
  2. proteinuria
  3. oedema

(oedema is no longer used in diagnosis as this is a normal feature of pregnancy)

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5
Q

What is the difference between pre-eclampsia and pregnancy-induced hypertension?

A

pregnancy-induced HTN:

  • HTN occurring after 20 weeks gestation
  • WITHOUT proteinuria

pre-eclampsia:

  • HTN occurring after 20 weeks gestation
  • this is associated with organ damage - most notably proteinuria
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6
Q

What is the underlying cause of pre-eclampsia?

A
  • there is high vascular resistance in the spiral arteries

AND

  • there is poor perfusion of the placenta
  • oxidative stress in the placenta releases inflammatory chemicals
  • there is systemic inflammation + impaired endothelial function in blood vessels
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7
Q

What are the high risk factors for pre-eclampsia?

A
  • previous HTN in pregnancy
  • pre-existing HTN
  • diabetes
  • chronic kidney disease
  • existing autoimmune conditions (e.g. SLE)
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8
Q

What are the moderate risk factors for pre-eclampsia?

A
  • age > 40
  • BMI > 35
  • more than 10 years since last pregnancy
  • multiple pregnancy
  • first pregnancy
  • FHx of pre-eclampsia
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9
Q

Why is it important to identify the RFs for pre-eclampsia?

A
  • they are used to determine who is offered prophylaxis with aspirin 150mg
  • women are offered aspirin from 12 weeks gestation if they have 1 high RF or 2+ moderate RFs

it is better to take aspirin at night

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10
Q

What are the symptoms of pre-eclampsia?

A
  • visual disturbances / blurriness
  • headache
  • facial oedema
  • reduced urine output
  • brisk reflexes / clonus
  • N&V
  • upper abdominal / epigastric pain

pain is due to swelling of the liver

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11
Q

How is pre-eclampsia diagnosed?

A
  • systolic BP > 140 mmHg

AND

  • diastolic BP > 90 mmHg

PLUS ANY OF:

  1. proteinuria
  2. organ dysfunction
  3. placental dysfunction
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12
Q

How can placental dysfunction be identified?

A
  • foetal growth restriction
  • abnormal Doppler studies
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13
Q

How can organ dysfunction be identified?

A
  • raised creatinine
  • elevated liver enzymes
  • seizures
  • thrombocytopenia
  • haemolytic anaemia
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14
Q

What test should be used on ONE occassion during pregnancy in suspected pre-eclampsia?

A

placental growth factor (PlGF)

  • this is released by the placenta to stimulate development of new blood vessels
  • levels will be LOW in pre-eclampsia
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15
Q

When should PlGF testing be performed?

A
  • it should be performed on one occasion
  • between 20 and 35 weeks gestation
  • to RULE OUT pre-eclampsia
16
Q

How can proteinuria be quantified?

A

urine protein:creatinine ratio:

  • above 30mg/mmol is significant

urine albumin:creatinine ratio:

  • above 8mg/mmol is significant
17
Q

How are women monitored for pre-eclampsia?

A

at every antenatal appointment, the following are performed:

  • blood pressure
  • assessment of symptoms
  • urine dipstick for proteinuria
18
Q

What is the management for gestational HTN (without proteinuria)?

A
  • urine dipstick at least weekly
  • blood tests weekly (FBC, U&Es, LFTs)
  • monitoring foetal growth with serial growth scans
  • PlGF testing on one occasion

  • the aim is for BP < 135/85 mmHg
  • admission is needed when BP > 160/110 mmHg
19
Q

What is the difference in management when pre-eclampsia is diagnosed?

A
  • BP monitored at least every 48 hours
  • urine dipstick NOT required as diagnosis is made
  • US of fetus, amniotic fluid & dopplers every 2 weeks
20
Q

What is used to help determine whether to admit someone with pre-eclampsia?

A

scoring systems - fullPIERS or PREP-S

21
Q

What are the 1st, 2nd and 3rd line treatments for pre-eclampsia?

A
  • labetalol is first line
  • nifedipine (MR) is second-line
  • methyldopa is third-line

!! beta blockers are contraindicated in asthma !!

methyldopa MUST be stopped within 2 days of birth

22
Q

What may be used in severe pre-eclampsia?

A

IV hydralazine

  • used in critical care in severe pre-eclampsia or eclampsia
23
Q

What is the additional management for pre-eclampsia during labour?

A

IV magnesium sulphate:

  • given during labour and for 24 hours afterwards
  • used to prevent seizures

fluid restriction:

  • used in severe pre-eclampsia / eclampsia to avoid fluid overload
24
Q

If the blood pressure cannot be controlled with pre-eclampsia, what may be done?

A
  • planned early birth may be necessary
  • corticosteroids should be given to help mature the fetal lungs
25
Q

Following delivery, how should pre-eclampsia be managed?

A
  • enalapril is first line
  • nifedipine / amlodipine are first line in black African or Caribbean patients
  • labetalol / atenolol are third line

the BP will return to normal over time once the placenta is removed

26
Q

What is eclampsia?

How is it treated?

A
  • this refers to seizures associated with pre-eclampsia
  • IV magnesium sulphate is used to manage the seizures
27
Q

What syndrome can occur as a result of pre-eclampsia / eclampsia?

A

HELLP syndrome:

  • Haemolysis
  • Elevated Liver enzymes
  • Low Platelets

monitored through regular blood tests - FBC, LFTs, coagulation

28
Q

When should labour be induced where there is HTN in pregnancy?

A
  • induce labour at 37 weeks in pre-eclampsia
  • induce labour at 40 weeks in pregnancy-induced HTN (without proteinuria)

Y4 - GOSH (62 decks)

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