Pre-Eclampsia

Question 1

Describe the pathophysiology of pre eclampsia (6)

Answer 1

• pregnancy increases plasma volume and vasodilation of blood vessels occurs due to effects of progesterone causing systemic vascular resistance
• colloid osmotic pressure is force resulting from plasma proteins retained in vessels due to their size but it decreases in pregnancy due to dilutions effect of expanded blood volume
• immune response to developing trophoblasts which causes defective placentation as spiral arteries not properly invaded and remodelled so blood flows through at lower volume and higher pressure leading to placental ischaemia and decreases placental perfusion IUGR and widespread endothelial cells dysfunction causing vasoconstriction and disruption of clotting
• disproportionate increase of plasma vol over RBCs causes loss of interstitial fluid compartment in capillary bed giving rise to oedema

Question 2

Complications of pre eclampsia (14)

Answer 2

Eclampsia
Decreases placental perfusion
Pre term labour
IUGR
placental abruption
Laryngeal oedema
Increased perinatal morbidity and mortality
Liver rupture
Cerebral haemorrhage
Retroplacental haemorrhage
Retinal detachment
Stillbirth
Pulmonary oedema
HELLP syndrome

Question 3

Risk factors for pre eclampsia (9)

Answer 3

Family HX of eclampsia pre eclampsia or hypertension
SLE
renal Disorders
Renal artsy stenosis
Collagen vascular disease
Phaemochromocytoma
Age >40
Essential hypertension
Diabetes

Question 4

Define chronic hypertension

Answer 4

Hypertension present at booking or before 20/40 or this being treated at time of referral to maternity services

Question 5

Define mild hypertension

Answer 5

Diastolic 90-99 and systolic 140-149

Question 6

Define moderate hypertension

Answer 6

Diastolic 100-109 systolic 150-159

Question 7

Define severe hypertension

Answer 7

Diastolic more than 110 and systolic more than 160

Question 8

Define eclampsia

Answer 8

The convulsive condition that comes with pre eclampsia

Question 9

Define gestational hypertension

Answer 9

New hypertension that presents after 20/40 without significant proteinurea

Question 10

Define pre eclampsia

Answer 10

New hypertension presenting after 20/40 with significant proteinurea

Question 11

Define severe pre eclampsia

Answer 11

Pre eclampsia with severe hypertension and with symptoms and biochemical/haematological impairment

Question 12

What’s your care plan for Lisa who has significant proteinurea and high BP at her 28/40 appointment?

Answer 12

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