Pre-eclampsia

Question 1

pathophysiology of pre-eclampsia

Answer 1

during normal placental development, trophoblasts invade into spiral A of uterine endometrium and remodel maternal A into much larger blood vessels with lower resistance to blood flow. In preeclampsia, spiral arteiers dont adapt so there is insufficient blood supply to placenta causing it to release pro-inflam cytokines, endoglin and anti-angiogenic proteins (s-Flt [soluble fms-like tyrosine kinase 2]

Question 2

systemic effects of pre-eclampsia on mothers

Answer 2

excess salt and water retention, weight gain, odema, hypertension, proteinuria. Arterial spasms in kindey, brain and liver. Renal blood flow and GFR is reduced. Protein deposits on basement membrane so thickened glomerular tufts

Question 3

What is eclampsia

Answer 3

Towards the end of pregnancy, this is an extreme vascular spasm throughout body causing seizures and coma in mothers, greatly decreases kidney output, malfunction in liver, extreme hypertension. Can be reversed with vasodialating drugs and termination of pregancy

Question 4

Outcome for babies

Answer 4

increase mortality during neonatal period and first year. Increase risk of morbidities such as respiratory illness and CP, Increase risk of diabetes and CVD later in life due to endocrine and mtabolic disruption in early life

Question 5

predictive tests for disease

Answer 5

PIGF (placental growth factor)- angiogenesis of placenta
sFlt/PIGF ratio
if PIGF less than 12 suggests severe placental dysfunction and between 12-100 suggests placental dysfunction likely

Question 6

Risk factors for pre-eclampsia

Answer 6

first pregancy, >40yrs, multiple pregancies, diabetes, inc BP, CKD, BMI >35

Question 7

prevention of pre-eclampsia

Answer 7

Asprin and anti-hypertensives