Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OBGYN 4MB > Pre-Eclampsia > Flashcards

Pre-Eclampsia Flashcards

1
Q

Define pre-eclampsia

A

Multisystem disorder unique to human pregnancy characterised by hypertension and involvement of one or more other organ systems and/or the fetus.

It is placental in origin and is cured only by delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the clinical parameters needed to diagnose pre-eclampsia?

A

HTN - BP >140/90 >20wks PLUS >/=1 of:

  1. Proteinuria - PCR > 30mg/mmol (0.3mg/m) or >300mg/day
    OR in the absence of proteinuria
  2. Other maternal organ dysfunction:
    - Renal insufficiency
    - Haematological involvement
    - Liver involvement
    - Neurological involvement
    - Pulmonary oedema
  3. Uteroplacental dysfunction (IUGR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the guideline used in the management of pre-eclampsia?

A

HSE CPG 2011 - The Diagnosis and Management of Pre-Eclampsia and Eclampsia (revised 2016)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List the risk factors for pre-eclampsia

A
  1. Primigravada
  2. Previous hx PET
  3. Pre-existing essential HTN
  4. Family hx PET (mother/sister)
  5. Diabetes
  6. Autoimmune disease
  7. Renal disease
  8. Extremes of reproductive age
  9. Multiple pregnancy
  10. Molar pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the incidence of pre-eclampsia?

A

2-3% of all pregnancies (5-7% of nulliparous women)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What features are present in the history of a woman with pre-eclampsia?

A 
Often asymptomatic
HTN detected at routine ANC
Later symptoms:
1. Frontal headache
2. Drowsiness
3. Nausea and vomiting 
4. Reduced fetal movements 
5. Visual symptoms (raised ICP)
6. Oliguria (renal failure)
7. Abdominal pain (distension of hepatic capsule)
8. Seizures (eclampsia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What signs are present on examination of a woman with pre-eclampsia?

A

General:

  1. HTN
  2. Oedema (esp facial and fingers)

Neurological:

  1. Papilloedema
  2. Hyper-reflexia clonus (cerebral oedema)
  3. Fundoscopy - papilloedema

Resp:
1. Pulmonary oedema

Abdominal:

  1. Small fundus (IUGR/oligohydramnios)
  2. RUQ tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List the investigations done in suspected pre-eclampsia

A

Maternal:

  • Bloods:
    1. FBC - reduced platelets
    2. Coag
    3. Uric acid
    4. U&E - abnormal renal function
    5. LFTs - abnormal LFTs
  • Urine:
    1. Urinalysis/MSU - exclude UTI
    2. 24hr urine for proteinuria - >0.3g/34hr

Fetal:

  1. US - fetal weight & growth, AFI, umbilical artery Doppler
  2. CTG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do we cure pre-eclampsia?

A

Cured only by delivery of the fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can we manage pre-eclampsia?

A
  • > 37wks = delivery by IOL
  • Severe PET = delivery by LSCS
  • <37wks = conservative treatment to prolong pregnancy subject to continuous fetal and maternal monitoring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What conservative treatment measures can be used in pre-eclampsia?

A
  1. Anti-hypertensives
  2. Seizure prophylaxis
  3. Corticosteroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the anti-hypertensive agents used in pregnancy?

A
  1. Labetalol - mixed alpha and beta adrenergic antagonist that produces a significant reduction in maternal blood pressure without any pronounced fetla effects)
    * Aim to keep SP <130-155 and DP <80-100
  2. Methyldopa - centrally acting antihypertensive which does not appear to have any adverse effect on the uteroplacental circulation
  3. Nifedipine - calcium channel blocker
  4. Hydralazine - IV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is used for seizure prophylaxis?

A

Magnesium sulphate - until 48hrs post partum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why and when are corticosteroids used?

A

Used for fetal lung maturation

Up to 36+6wks - betamethasone - 2 doses 24hrs apart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List the complications of pre-eclampsia

A

Fetal:

  1. IUGR
  2. Oligohydramnios
  3. Placental abruption
  4. Death
  5. Sequelae of prematurity

Maternal:

  1. Eclampsia
  2. Cerebrovascular accident
  3. HEELP syndrome
  4. DIC
  5. Pulmonary oedema
  6. ARDS
  7. Liver failure
  8. Renal failure
  9. Death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is HELLP syndrome?

A 
H = haemolysis
EL = elevated liver enzymes 
LP = low platelets
17
Q

What features would be present on history of HELLP syndrome?

A
  1. Nausea and vomiting
  2. Abdo pain
  3. Headache
  4. Visual disturbances
18
Q

What would you expect to find on examination of a patient with HELLP syndrome?

A
  1. Jaundice
  2. RUQ tenderness
  3. Hepatomegaly
  4. Easy bruising/purpura
19
Q

What investigations should be performed if HELLP syndrome is suspected?

A
  1. LFTs - elevated AST, ALT, LDH

2. FBC - reduced platelets

20
Q

How is HELLP syndrome managed?

A

Delivery of the baby

21
Q

How can pre-eclampsia be prevented?

A

Aspirin in future pregnancy - from 12wks until birth

RISK IN FUTURE PREGNANCY = 1 in 6 (16%)

OBGYN 4MB (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions