Pre-eclampsia Flashcards
What is pre-eclampsia?
A multi system disorder of pregnancy
With confirmed hypertension of >140/90
With >=300 mg of protein in 24 hr urine
Arising de novo after 20 weeks gestation
In a previously normotensive woman
And resolves completely by 6 weeks postpartum
What are the clinical spectra of pre-eclampsia?
Pre-eclampsia
Severe eclampsia and HELLP
Imminent eclampsia
Eclampsia
What are the risk factors for developing pre-eclampsia?
#extreme risk Past Hx of severe eclampsia Pre-eclampsia needing PTB at 34 PET with IUGR IUD Placental abruption
#high risk Hx of hypertensive disorders in pregnancy Chronic hypertension CKD Type 1 and 2 DM SLE APLS Thrombophilias Hydatidiform mole Fetal hydrops
#moderate Primigravid Age > 40 Pregnancy interval of > 10 yrs Pre preg BMI > 35 Family history of pre-eclampsia (1st degree) Multiple pregnancy
What are the special interventions for mothers at risk of PET?
extreme risk
Aspirin 75 mg nocte from 12+0
USS for growth, AFV, UmAD every 4 weeks from 28+0
CTG if indicated
Aspirin
CTG if indicated
What is the pathophysiology of PET?
Can occur in any form of pregnancy
Two stage theory
Stage 1 defective trophoblast invasion prevents high flow low resistance UP circulation leading to ischemia
Stage 2 UP ischemia causes oxidative and inflammatory stress, cytokines released cause systemic endothelial dysfunction, vasospasm and clotting activation
CVS and renal effects cause generalized edema
Haematological - PLT down, fibrin deposit
Liver - fibrin damage, LE elevated, hemolysis
(HELLP)
Neurological- encephalopathy and convulsions
What are the clinical features of severe PET?
Symptoms Severe headache Vision blurring and flashing Severe epigastric pain Vomiting Sudden swelling of face hands and feet Convulsions Abdominal pain General malaise
Sings Right upper quadrant tenderness Hyper reflexia Clonus Papilloedema
Investigations Maternal Falling PLT LFT up LDH up Uric acid up
Fetal
USS asymmetrical growth IUGR
AFV, UmAD, CTG
