Pre-eclampsia Flashcards
Define pre-eclampsia
Diffuse vascular endothelial dysfunction with circulatory disturbance involving renal, hepatic, CV, CNS, coagulation system
- proteinuria, hypertension, oedema are most common manifestations
What are the most common manifestations of pre-eclampsia?
Hypertension
Proteinuria
Oedema may occur
Describe th pathophysiology of pre-eclampsia
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
What are the Sx of pre-eclampsia?
Generally asymptomatic and detected by screening
Headahe, visual disturbance, epigastric pain, vomiting, oedema (esp. facial) may occur
Define hypertension and proteinuria in pre-eclampsia
Systolic BP >140 mmHg or Diastolic BP > 100 mmHg
300 mg of preotin in a 24 hour urine sample
What are the effects of pre-eclampsia?
Decreased GFR
Proteinuria
Increased serum creatinine
Oliguria
Hyperuricaemia from placental ischaemia Reduced plasma volume Haemoconcentration Abnormal liver function Thrombocytopaenia
What are the compliations of pre-eclampsia?
Eclampsia (convulsions)
- LoC, tongue biting, incontinence
HELLP syndrome
Stroke (most common)
Intra Uterine Growth Restriction
Risk factors for pre-eclampsia
Previous pre-eclampsia Hypertension Diabetes Autoimmune disease Thrombophilias, e.g. factor V leiden Renal disease
What is HELLP syndrome?
Haemolysis
Elevated liver enzymes
Thrombocytopaenia (low platelets)
Can lead onto DIC
What Ix must be done to assess for HELLP syndrome?
FBC, AST/ALT, Clotting times
What Ix need to be done for pre-eclamptic patients?
BP, Proteinuria
USS to assess foetal status
Umbilical doppler to assess well-being of baby
- foelatal distress = absent flow/reverse back flow
Uric acid
What prophylactic measures can be done for pre-eclampsia?
Aspirin
Antioxidants
What should be given to treat pre-eclampsia?
Magnesium sulphate
- given as prophylaxis
How is pre-eclampsia cured?
Delivery of foetus and placenta
If pre-eclampsia resolves before birth what is this suggestive of?
Intrauterine death
What are the maternal indications for delivery in pre-eclampsia?
Eclampsia CVA - uncontrollable BP Pre-existing medical conditions AKI HELLP / coagulopathies
What are the foetal indications for delivery in pre-eclampsia?
Growth - measure head and abdo circumference
Decreased doppler
Decreased liquor volume
What drugs can be used for treating hypertension in pregnancy?
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
What should be given for acute severe pre-eclampsia?
Diuretic therapy for pulmonary oedema
