Pre-eclampsia Flashcards
What is pre-eclampsia?
New high blood pressure in pregnancy with end-organ dysfunction, notably proteinuria
Occurs after 20 weeks gestation when spiral arteries of placenta form abnormally, leading to high vascular resistance.
What defines chronic hypertension in pregnancy?
Hypertension prior to 20 weeks gestation and is longstanding, not caused by dysfunction in placenta
What is pregnancy-induced hypertension?
Hypertension occurring after 20 weeks gestation without proteinuria
What is the relationship between pre-eclampsia and proteinuria?
Pre-eclampsia is pregnancy-induced hypertension with organ damage and proteinuria
What is eclampsia?
Seizures occur as a result of pre-eclampsia
List high-risk factors for pre-eclampsia
- Pre-existing hypertension
- Previous hypertension in pregnancy
- Existing autoimmune disease (e.g. SLE)
- Diabetes
- Chronic kidney disease
List moderate-risk factors for pre-eclampsia
- > 40 years old
- BMI >35
- > 10 years since previous pregnancy
- Multiple pregnancy
- First pregnancy
- Family history of pre-eclampsia
What are the classic triad features of pre-eclampsia?
- Hypertension
- Proteinuria
- Oedema
What are other symptoms of pre-eclampsia?
- Headache
- Visual disturbance
- Nausea and vomiting
- Upper abdominal or epigastric pain
- Reduced urine output
- Brisk reflexes
What blood pressure readings indicate a diagnosis of pre-eclampsia according to NICE 2019?
Systolic BP >140mmHg and diastolic BP >90mmHg
What additional criteria can confirm a diagnosis of pre-eclampsia?
- Proteinuria (PCR ratio >30; ACR ratio >8)
- Organ dysfunction (e.g. raised creatinine, elevated liver enzymes)
- Placental dysfunction (e.g. fetal growth restriction)
What is the prophylactic treatment for high-risk individuals in pre-eclampsia?
Aspirin given from 12 weeks until birth
What is the target blood pressure for gestational hypertension without proteinuria?
Aim for BP <135/85
What is the management for severe pre-eclampsia?
- Labetalol (1st line)
- Nifedipine (2nd line)
- Methyldopa (3rd line)
- IV hydralazine (in severe cases)
- IV magnesium sulphate (during labor and 24hrs after)
What is the purpose of corticosteroids in planned early birth for pre-eclampsia?
To help mature fetal lungs
What is HELLP syndrome?
A combination of features that occur as a complication of pre-eclampsia and eclampsia
What does HELLP stand for?
- H: Haemolysis
- E: Elevated Liver enzymes
- L: Low Platelets
How is eclampsia managed?
With IV magnesium sulphate
Fill in the blank: Pre-eclampsia occurs after _______ weeks gestation.
20
