Pre-eclampsia

Question 1

Define pre-eclampsia

Answer 1

Diffuse vascular endothelial dysfunction with circulatory disturbance involving renal, hepatic, CV, CNS, coagulation system
- proteinuria, hypertension, oedema are most common manifestations

Question 2

What are the most common manifestations of pre-eclampsia?

Answer 2

Hypertension
Proteinuria

Oedema may occur

Question 3

Describe th pathophysiology of pre-eclampsia

Answer 3

Genetic predispostion

Poor implantation or development of placenta and trophoblast invasion => uderperfusion and placental ischaemia

GFR decreases in pregnancy => pre-eclampsia can cause permanent renal damage

Question 4

What are the Sx of pre-eclampsia?

Answer 4

Generally asymptomatic and detected by screening

Headahe, visual disturbance, epigastric pain, vomiting, oedema (esp. facial) may occur

Question 5

Define hypertension and proteinuria in pre-eclampsia

Answer 5

Systolic BP >140 mmHg or Diastolic BP > 100 mmHg

300 mg of preotin in a 24 hour urine sample

Question 6

What are the effects of pre-eclampsia?

Answer 6

Decreased GFR
Proteinuria
Increased serum creatinine
Oliguria

Hyperuricaemia from placental ischaemia
Reduced plasma volume
Haemoconcentration
Abnormal liver function
Thrombocytopaenia

Question 7

What are the compliations of pre-eclampsia?

Answer 7

Eclampsia (convulsions)
- LoC, tongue biting, incontinence

HELLP syndrome

Stroke (most common)

Intra Uterine Growth Restriction

Question 8

Risk factors for pre-eclampsia

Answer 8

Previous pre-eclampsia
Hypertension
Diabetes
Autoimmune disease
Thrombophilias, e.g. factor V leiden
Renal disease

Question 9

What is HELLP syndrome?

Answer 9

Haemolysis
Elevated liver enzymes
Thrombocytopaenia (low platelets)

Can lead onto DIC

Question 10

What Ix must be done to assess for HELLP syndrome?

Answer 10

FBC, AST/ALT, Clotting times

Question 11

What Ix need to be done for pre-eclamptic patients?

Answer 11

BP, Proteinuria

USS to assess foetal status

Umbilical doppler to assess well-being of baby
- foelatal distress = absent flow/reverse back flow

Uric acid

Question 12

What prophylactic measures can be done for pre-eclampsia?

Answer 12

Aspirin

Antioxidants

Question 13

What should be given to treat pre-eclampsia?

Answer 13

Magnesium sulphate

- given as prophylaxis

Question 14

How is pre-eclampsia cured?

Answer 14

Delivery of foetus and placenta

Question 15

If pre-eclampsia resolves before birth what is this suggestive of?

Answer 15

Intrauterine death

Question 16

What are the maternal indications for delivery in pre-eclampsia?

Answer 16

Eclampsia
CVA - uncontrollable BP
Pre-existing medical conditions
AKI
HELLP / coagulopathies

Question 17

What are the foetal indications for delivery in pre-eclampsia?

Answer 17

Growth - measure head and abdo circumference
Decreased doppler
Decreased liquor volume

Question 18

What drugs can be used for treating hypertension in pregnancy?

Answer 18

1st line = methyldopa
2nd line = nifedipine or hydralazine
3rd line = labetalol, alpha-blockers

Dexamethasone in high dose can be given in 2 doses (24 hrs apart) to help bay survive in womb
- lasts up to ten days, must deliver by then

Question 19

What should be given for acute severe pre-eclampsia?

Answer 19

Diuretic therapy for pulmonary oedema