Pre-eclampsia

Question 1

What is pre-eclampsia?

Answer 1

The development of HYPERTENSION + PROTEINURIA after the first 20 weeks of gestation

Hypertension is defined as a systolic pressure of >140mmHg or diastolic pressure of >90mmHg on two or more occasions
Proteinuria is defined as the presence of urinary protein in concentrations greater than 0.3g/L in a 24hr collection

Question 2

What is eclampsia?

Answer 2

The development of convulsions secondary to pre-eclampsia in the mother.

This is due to decreased vascular resistance, leading to excessive blood flow to the brain and subsequent seizures

Question 3

Describe the pathophysiology of pre-eclampsia

Answer 3

It is a disorder of the spiral arteries. For some reason they do not connect properly to the placenta so there is inadequate blood flow to the foetus.

To compensate, the body increases the BP, and this causes HTN, as well as damaging the kidney and causing proteinuria

Question 4

What are the symptoms of pre-eclampsia?

Answer 4

Nausea and vomiting
Epigastric pain
Headache
Visual disturbance
Rapid onset oedema

Question 5

What are the high risk factors for pre-eclampsia?

Answer 5

CKD, history of pre-eclampsia, pre-existing diabetes, chronic hypertension, autoimmune disease, multiple UTIs

Question 6

If the patient has any high risk factor or 2 moderate risk factors for pre-eclampsia, what treatment should they receive?

Answer 6

75mg aspirin daily from 12 weeks

Question 7

What are the moderate risk factors for pre-eclampsia?

Answer 7

Age > 40, first pregnancy, pregnancy interval >10 years, BMI>35, FHx, multiple pregnancy

Question 8

What are the complications of pre-eclampsia?

Answer 8

• Eclampsia
• Cerebrovascular haemorrhage
• Liver and coagulation problems
• Kidney failure
• Pulmonary oedema
• HELLP syndrome
• DIC
• Placental abruption
• IUGR
• IUD

Question 9

What does HELLP stand for?

Answer 9

• Haemolysis
• Elevated Liver enzymes
• Low Platelet count

It is a life threatening liver disorder, associated with severe pre-eclampsia

Question 10

What is the first line treatment for pre-eclampsia?

Answer 10

Oral/IV labetolol

Second line = methyldopa or nifedipine

Question 11

What is the first line treatment for eclampsia ? (also used prophylactically)

Answer 11

IV magnesium sulphate

4g loading dose followed by 1g/h for 24-48 hours

Question 12

Which antihypertensives are contraindicated in pregnancy?

Answer 12

ACE inhibitors

ARBs

Question 13

How often should those with gestational hypertension be monitored?

Answer 13

Twice weekly BP and urinalysis

Question 14

How often should those with pre-eclampsia be monitored, and what tests should be done?

Answer 14

ADMITTED
4x daily BP
FBC/U&E/LFT 2/3x weekly depending on severity
USS for growth/AFI/doppler

Question 15

How should subsequent pregnancies be managed?

Answer 15

• Prophylactic 75mg aspirin daily from 12 weeks until term
• Uterine artery doppler at 23 weeks
• Serial grwoth/AFI/Doppler

Question 16

What is the risk to the newborn baby of taking labetolol?

What can be done to minimise this risk?

Answer 16

It can cause neonatal hypoglycaemia, so the baby will need an early feed and 3hourly prefeed glucose

Question 17

Why does fluid intake need to be managed in pre-eclamptic patients?

Answer 17

It could lead to pulmonary oedema