Pre-Eclampsia

Question 1

Pre-Eclampsia

Answer 1

S > 140 OR D >90… + 1 of:
300mg proetinuria (on 24 hour urine sample)
thrombocytopenia (

Question 2

What is the underlying physiology of pre-eclampsia

Answer 2

endothelial cell dysfunction (maternal vasospasm)… likely starting from inadequate trophoblastic invasion of maternal spiral arteries into decidua.
This endo cell dysfunction –> HTN in vessles, proteinuria (from endo cells in glomerulus), headache (endo cells in brain).

Question 3

What maternal complications do you worry about with preeclampsia?

Answer 3

CNS problems (seizure so can start on magnesium)
pulmonary edema
renal failure
hematologic: hemorrhage/DIC

Question 4

What fetal complications do you worry about with preecelampsia?

Answer 4

preterm delivery
placental abruption
IUGR (lack of nutrients across placenta)
fetal death

Question 5

What is required for severe preeclpamsia?

Answer 5

ANY 1 of:
S>160
D>110
proteinura 5g or more
oliguria (

Question 6

What is the treatment for preeclampsia?

Answer 6

if severe… magnesium sulfate is given just as prophylaxis for seizures…

Question 7

What tests would you run in a patient suspected to have preeclampsia?

Answer 7

CBC (increasing hct may signify worsening vasoconstriction)
platelet count
coagulation profile (PT, PTT)
liver function studies (ALT and AST)
serum creatinine (>1.1 is bad)
increased uric acid levels

Question 8

How is HTN managed?

Answer 8

if S >150 or D >100… then patient is started on anti-HTN (methyldopa, labetalol, nifedipine) with the goal of maintaining D between 90-100!

Question 9

What drugs should NOT be used to manage HTN in pregnancy?

Answer 9

ACE-I’s and ARBs are teratogenic!!!

Question 10

What is the management of mild preeclampsia?

Answer 10

if present at 37 weeks then delivery is indicated. before 37 is frequent monitoring for IUGR etc. Twice weekly NSTs with AFI

Question 11

What are therapeutic levels of magnesium sulfate?

Answer 11

4-6 mg/dL!

Question 12

What should be frequently assessed in a patient on magnesium?

Answer 12

patellar reflex (can be lost with levels around 8-12)
*Pulmonary edema can occur with ANY amount of Magnesium sulfate!

Question 13

How do you reverse magnesium toxicity?

Answer 13

10% calcium gluconate SLOWLY via IV + oxygen

Question 14

When are seizures most likely to occur in a patient with preeclampsia?

Answer 14

25% within 24 hours before delivery
50% during delivery
25% within 24 hours after delivery

Question 15

How are seizures treated in pregnancy and preeclampsia?

Answer 15

The seizures are typically self-limiting… but the patient is simply given magnesium to prevent a future seizure