Pre-eclampsia Flashcards
Hypertension in pregnancy (classification)
- Gestational hypertension
- Preeclampsia
- Chronic hypertension
- Preeclampsia superimposed on chronic hypertension
Preeclampsia - definition
De novo hypertension arising after 20 weeks’ gestation, returning to normal within 3 months partum, plus evidence of dysfunction in at least one other organ (kidney, liver, neurological, haematological, fetal)
Gestational hypertension - definition
De novo hypertension after 20 weeks’ gestation without any other features of preeclampsia, returning to normal within 3 months postpartum
Chronic hypertension - definition
Hypertension in the first half of pregnancy (can be essential or secondary)
Preeclampsia - epidemiology
- 5% of pregnancies (usually mild)
- Severe preeclampsia in 1% of pregnancies
Preeclampsia - risk factors
- Previous severe/early onset preelampsia
- Family history (mother or sister)
- Pre-existing medical conditions (4) - hypertension, renal disease, DM, antiphospholipid antibodies
Preeclampsia - symptoms
- Headache (esp. frontal, but very common without PET)
- Visual disturbance (esp. flashing lights, but very common without PET)
- Epigastric or RUQ pain in abdomen
- Nausea and vomiting
- Rapid oedema (esp. face)
Note - symptoms usually occur only with severe disease
Preeclampsia - signs
- Hypertension (>140/90, severe if >/=160/110)
- Facial oedema
- Confusion
- Hyperreflexia and/or clonus (>3 beats) = sign of cerebral irritability
- Uterine tenderness or vaginal bleeding from a placental abruption
Preeclampsia - ix
- FBE (thrombocytopenia)
- Coagulation profile
(mildly prolonged PT and APTT) - Urine stuff (3) - urinalysis, UEC (increased urea, creatinine and protein), 24 hour urine collection or split protein:creatinine ratio
- LFTs (increased transaminases)
- LDH (increased; a marker of haemolysis)
Pre-eclampsia - mx
- Give antihypertensive medications if sBP =/> 160mmHg and/or dBP =/> 100mmHg (due to risk of intracerebral haemorrhage and eclampsia)
- Medications to use = methyldopa, oxprenolol, labetalol, clonidine (first line). Second line = hydralazine, nifedipine, prazosin (if additional tx needed)
- Avoid ACEi, angiotensin II receptor antagonists and diuretics
- BP =/>170/110 = medical emergency. Lower BP promptly but be careful not to impair placental perfusion further. Use IV hydralazine or labetalol, or oral nifedipine to lower BP over 30-60 mins. Monitor fetus during BP lowering
- IV magnesium sulfate for prevention of eclampsia
Preeclampia (severe) - indications for immediate delivery
- Worsening thrombocytopenia or coagulopathy
- Worsening liver or renal function
- Severe maternal symptoms, especially epigastric pain with abnormal LFTs
- HELLP syndrome or eclampsia
- Fetal reasons such as abnormal CTG or reversed umbilical artery end diastolic flow
Preeclampsia - severe complications
- Eclampsia
- HELLP
- Cerebral haemorrhage
- IUGR and fetal compromise
- Placental abruption
Preeclampsia - postpartum mx
- Resolution of preeclampsia commences following delivery of placenta but may take days, weeks or even months
- BP should have returned to normal within 3mo. If not, search for underlying essential or secondary HTN
- Urinalysis and urine microscopy should be normal by 12mo postpartum. If not, search for primary underlying renal disease
- Recurrence of preeclampsia or gestational HTN in subsequent pregnancy = 15%
- Women with preeclampsia are at an increased risk of CVD, VTE and HTN within the 15y following their pregnancy. Encourage regular exercise, healthy eating and review of CVD risk factors
