Pre-eclampsia

Question 1

Define pre-eclampsia

Answer 1

A disorder of hypertension and proteinuria due to placental problems

Question 2

Investigations

Answer 2

Urine dip
BP

Question 3

If the urine dip is positive for proteins, what do you have to do?

Answer 3

Quantify level of proteinuria by doing an albumin to creatinine ratio or protein to creatinine ratio

Question 4

Protein to creatinine ratio - what is the threshold for significant proteinuria?

Answer 4

Over 30mg/mmol

Question 5

If there’s an albumin to creatinine ratio, what is the threshold for diagnosis?

Answer 5

8mg/mmol

Question 6

Symptoms/signs of severe pre-eclampsia

Answer 6

Sudden swelling of face, hands and feet
Severe headache
Vision problems e.g. blurring or flashing eyes
Severe pain below ribs
Vomiting

Question 7

What is considered severe hypertension?

Answer 7

160/110mg

Question 8

What is the management for severe preeclampsia?

Answer 8

Hospital admission for monitoring of baby and mum

Question 9

Management for pre-eclampsia

Answer 9

75-150mg aspirin daily from week 12 gestation until birth

Question 10

When should you speak specialist advise about prescribing aspirin?

Answer 10

If they are under 16, or if they have thrombophilia or uncontrolled blood pressure

Question 11

Aspirin baby risk

Answer 11

Low dose aspirin - no evidence of increased risk of congenital abnormalities

Question 12

High risk factors for pre-eclampsia

Answer 12

HTN during previous pregnancy
CKD
Autoimmun edisease e.g. SLE or antiphospholipid syndrome
T1/2 diabetes
Chronic HTN

Question 13

Moderate risk factors for pre-eclampsia

Answer 13

First pregnancy
40 or older
Pregnancy interval of more than 10 years
BMI of 35 or more at first visit
FH of pre-eclampsia
Multiple pregnancy

Question 14

Drugs prescribed for preeclampsia

Answer 14

Asprin
Labetalol (CI in asthma)
Methyldopa (stopped after birth due to risk of ?)
Nifedipine

Question 15

Complications

Answer 15

Preterm labour
IUGR
Stillbirth
Spontaneous miscarriage