pre-eclampsia Flashcards
diff between pre-eclampsia and gestational hypertension
gestational hypertension NO proteinuria and ASYMPTOMATIC
pre-eclampsia
new onset hypertension > 20 WEEKS proteinuria OR low platelets abnormal liver enzymes renal impairment
factors that increase risk of preeclampsia include
high maternal age high BMI BP bleeding in T1 pre-conception relationship < 6 months FHx of CVD or pre eclampsia low maternal birth weight
factors that reduce risk of preeclampsia
smoking in 1st trimester
miscarriage same partner
attemt to conceive> 12 months
using clinical risk factors what % of women can be identified
50% but only at a 20% screen positive rate, 1 in 5 women get screened positive, only 50% of those at risk
trophoblast cells line
placental villi - these cells make placental growth factor, relaxes mother’s vessels, can also release anti-angiogenic factors
in Down syndrome PAPPA is
Low!
in second trimester measure AFP Estriol Inhibin A hCG
AFP - made by baby’s liver, can become elevated if placenta is injured
Inhibin and HcG come from
Trophoblastic surface
When things are abnormal what happens to Inhibia A and HCG
Overproduction of those hormones
Multiple Abnormal IPS is rare but has a %? for delivery < 32 weeks?
75% PPV
What does the placenta look like when injured
- small
Thick
areas of poor development
Uterine artery doppler can show ?
Lower blood flow and nourishment to baby
75% of early onset IUGR/PET
How do we maintain acuity in cornea when so avascular?
VEGF1 peripherally produced - SVED - prevents abnormal angiogenesis (suppress angiogenesis, secreted as a soluble receptor)
In severe preeclampsia you have high levels of
sFLT-1 - vasoconstriction, and endothelial dysfunction
anti-angiogenic properties, less growth factor stimulation of endothelium
sFLT1/PIGF ratio
can become quite high
if PlGF1 levels are very low
increased risk of bleeding IUGR, and early delivery
number1 cause of maternal mortality
eclampsia
Trreatment for HTN in antenatal period includes
Labetalol - B blocker
Nifedipine
Methyl dopa
Intrapartum treatment preeclampsia
restrict fluid intake
IV Mg So4
oral/IV antihypertensives
post-partum care - high risk of DVT
DVT prophylaxis
what additional treatments can be given to prevent preeclapmsia
heparin
aspirin
small for gestational age
estimated Fetal Weight, or birth weight below a specific centile - nbelow 3rd all fetuses growth restricted
IUGR is
fetus failing to achieve it’s growth potential
FETAL GROWTH curve -
LMP and cycle-adjusted lmp have an error of
14 and 7 days
in early onset growth restriction there is a
primary defect in placental formation
if a baby has low oxygen saturation it will
increase blood flow to the brain
usualyl diastolic flow is very low and baby o2 status is good
late onset IUGR
high blood flow to brain
placenta injured
NORMAL umbilical blood cord flow
If you have delayed delivery of the baby
increased risk of IUGR below 3rd percentile and increase pre eclampsia risk
late losses of babies - still births are often due to
placental insufficiency, earlu losses are more congenital or aburption
most important cause of still birth
failture to recognize growth restriction placental dysfunction
in the BK test
fetal cells retain hemoglobin - dont get washed out by acid
preventing still births in low resrouces settings
obstetrical care most important
Screenign needs
Precision
and need intervention to be more relevant that false positives in normal people
