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3. Y5 Zero to finals: O&G > Pre-eclampsia > Flashcards

Pre-eclampsia Flashcards

1
Q

What is Pre-eclampsia?

A

New HTN @ pregnancy w End-organ dysfunction

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2
Q

What is the general Pathophysiology of Pre-eclampsia?

A

Poor placental perfusion, secondary to abn placentation

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3
Q

How an you understand Pathophysiology of Pre-eclampsia?

A

Compare normal Placentation vs Pre-eclampsia placentation

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4
Q

What are the steps for Normal placentation? (2 steps)

A
  1. Trophoblasts invades Endometrium + Spiral arteries –> Destroys tunica muscularis media
  2. Spiral arteries dilate –> High flow, low resistance circulation for pregnancy
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5
Q

What are the steps for Normal placentation in Pre-eclampsia? (3 steps)

A
  1. Spiral arteries remodelling incomplete –> Low flow, High resistance circulation for pregnancy
  2. Increase in BP + Hypoxia + Oxidative stress (bc inadeq uteroplacental perfusion)
  3. Systemic inflamm response + Endothelial cell dysfunction –> leaky blood vessels
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6
Q

What are the titles of RF for Pre-eclampsia? (2 things)

A
  1. High RF
  2. Moderate RF
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7
Q

What are the HIGH RF for Pre-eclampsia? (5 things)

A
  1. HTN
  2. Pre-eclampsia Hx
  3. AI conditions (e.g SLE)
  4. DM
  5. CKD
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8
Q

What are the MODERATE RF for Pre-eclampsia? (5 things)

A
  1. Age 40+
  2. BMI 35+
  3. 10+ yrs since previous preg
  4. 1st preg
  5. Pre-eclampsia FHx
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9
Q

How does number of RF affect Mx of Pre-eclampsia?

A
  1. 1+ HIGH RF: Aspirin
  2. 2+ MODERATE RF: Asprin
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10
Q

When should you offer women w RF Aspirin?

A

12 wks

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11
Q

What is a simple way to remember CF of Pre-eclampsia? (3 things)

A
  1. Proteinuria
  2. Rise in BP
  3. Edema

(PRE – eclampsia)

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12
Q

What are the CF Pre-eclampsia? (7 things)

A
  1. Headache
  2. Visual disturbance / blurriness
  3. N + V
  4. Brisk reflexes
  5. Upper abd / epigastric pain (bc liver swelling)
  6. Oedema
  7. Reduced urine output
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13
Q

What are the NICE guidelines for Dx of Pre-eclampsia?

A

BP reading + one Extra CF

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14
Q

What BP readings needed for for Dx of Pre-eclampsia? (2 things

A
  1. Systolic 140+
  2. Diastolic 90+
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15
Q

What are the CF needed for Dx of Pre-eclampsia? (3 things)

A
  1. Proteinuria (1+ on dipstick)
  2. Organ dysf CF
  3. Placental dysf (e.g foetal growth restriction / abn Doppler)

(only need 1 for Dx)

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16
Q

What CF suggest Organ dysfunction? (5 things)

A
  1. Raised creatinine
  2. Raised liver enzymes
  3. Seizures
  4. Thrombocytopaenia
  5. Haemolytic anaemia
17
Q

What investigation does NICE recommend for women w sus Pre-eclampsia?

A

Placental Growth Factor Testing (PlGF) (low in Pre-eclampsia)

18
Q

What are the Mx options for Gestational HTN (w/o proteinuria, aka NOT Pre-eclampsia)? (5 things)

A
  1. Tx n aim for BP below 135/85
  2. Admit if BP above 160/110
  3. Weekly bloods + urine dipstick
  4. Monitor foetal growth (serial growth scans)
  5. PlGF testing
19
Q

How do the Mx options change once Pre-eclampsia is Dx? (4 things)

A
  1. Same as Gestation HTN plus:
  2. BP monitor every 48 hrs at least
  3. Don’t need Dipstick anymore (bc Dx already made)
  4. US to monitor: Foetus / amniotic fluid / Dopplers (2 weekly)
20
Q

What are the MEDICAL Mx options for Pre-eclampsia? (6 things)

A
  1. Labetolol (anti-HTN) (FIRST LINE)
  2. Nifedipine (SECOND LINE)
  3. Methyldopa (THIRD LINE)
  4. IV hydralazine (SEVERE pre-eclampsia / eclampsia)
  5. IV Mg sulphate (during labour + 24 hrs after –> to prevent seizures)
  6. Fluid restriction
21
Q

What is important to know about Methyldopa as Tx for Pre-eclampsia?

A

Need to stop it within 2 days of birth

22
Q

When should you give IV Mg Sulphate in Pre-eclampsia?

A
  1. During labour
  2. 24 hours afterwards
23
Q

What is the point of giving IV Mg Sulphate in Pre-eclampsia Mx?

A

Preventing seizures

24
Q

When should you do Fluid restriction in Pre-eclampsia?

A

During labour

25
Q

What is the point of doing Fluid restriction in Pre-eclampsia Mx?

A

Avoid fluid overload

26
Q

What should you do for Pre-eclampsia when BP can’t be controlled?

A

Premature birth

27
Q

What should you give Pre-eclampsia women having a Premature birth? Why?

A
  • Corticosteroids
  • Help mature foetal lungs
28
Q

What should you monitor after delivery?

A

BP

29
Q

When will the BP go back to normal after delivery?

A

Once placenta is removed

30
Q

What Tx does NICE recommend you switch to after delivery? (3 things)

A
  1. Enalapril (FIRST LINE)
  2. Nifedipine / amlodipine (SECOND LINE) (FIRST LINE IN NIGGAS)
  3. Labetolol / Atenolol (THIRD LINE)
31
Q

What is Eclampsia?

A

Refers to seizures assoc w Pre-eclampsia

32
Q

What are the Mx options for Seizures (aka Eclampsia) assoc w Pre-eclampsia?

A

IV Mg Sulphate

33
Q

What is a complication of Pre-eclampsia?

A

HELLP Syndrome

34
Q

What are the CF of HELLP Syndrome? (3 things)

A
  1. Haemolysis
  2. Elevated Liver enzymes
  3. Low Platelets

(stands for HELLP)

3. Y5 Zero to finals: O&G (27 decks)

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