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Obs & Gynae > Pre-eclampsia > Flashcards

Pre-eclampsia Flashcards

1
Q

Definition of pre-eclampsia

A

New onset hypertension and/or* proteinuria after week 20 of pregnancy that resolves after delivery

*If or: need other features

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2
Q

Clinical features of pre-eclampsia (12)

A 
Severe headache (hydrocephalus)
Visual disturbance (photopsia, photophobia) 
Papilloedema 
Epigastric pain
Right upper quadrant pain
Facial swelling
Hands and feet swelling (leg swelling can be normal) 
Vomiting 
Hyperreflexia and clonus 
Elevated ALT/AST (raised ALP normal as produced by placenta)
HELLP
Raised urea and creatinine
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3
Q

Types of hypertensive disorders of pregnancy

A

<20 weeks is preexisting/chronic

>20 weeks is gestational/pre-eclampsia

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4
Q

Definition of eclampsia

A

Generalised convulsions during pregnancy, labour or within 7 days postpartum
Not caused by neurological disorder

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5
Q

Pathophysiology of pre-eclampsia

A

Trophoblast fails to invade maternal spiral arteries

Resulting in placenta not being a low pressure system

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6
Q

Definition of proteinuria in pregnancy

A

PCR at least 30mg/mmol
Or
At least 300mg in 24hr urine collection (gold standard but rarely done in practice)

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7
Q

Definition of hypertension in pregnancy

A

Diastolic BP >110
Or
>140/90 on 2 consecutive occasions >4 hours apart

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8
Q

Complications of pre-eclampsia

A 
Haemorrhagic stroke 
Eclampsia
HELLP syndrome 
Renal tubular necrosis
Pulmonary oedema
Hepatic haemorrhage within capsule
DIC
Placental infarction
Fetal death/growth restriction/prematurity
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9
Q

How to asses fetal risk in pre-eclampsia

A 
Fetal movements
CTG
Fetal size
Liquor volume
Umbilical artery Doppler
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10
Q

Criteria for hospital admission

A 
BP >170/110
Or
BP >140/90 with proteinuria
Or
Significant symptoms
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11
Q

What can be done to prolong pregnancy in pre-eclampsia

A

Steroids

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12
Q

Primary prevention of pre-eclampsia

A

Low dose aspirin BEFORE 24 weeks ~12

Calcium supplements

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13
Q

Secondary prevention of pre-eclampsia

A

Antihypertensive drugs for severe hypertension
NO DIURETICS
NO ACE INHIBITORS

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14
Q

Prevention and treatment of eclampsia seizures

What is its secondary benefit

A

Magnesium sulphate
Decreases risk of cerebral palsy in fetus

If ineffective, second line is lorazepam

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15
Q

Significance of urea and creatinine in pregnancy

A

Should be lower than normal range in pregnancy

If in normal range need more investigation!

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16
Q

Why can’t you give ACEi inhibitors for hypertension in pregnancy

A

Cause renal impairment in fetus

17
Q

Problem with lowering blood pressure too quickly

A

Blood flow directed to maternal brain and kidneys

Therefore flow restricted to uterus

18
Q

Drugs for emergency BP control in pregnancy

A

Nifedipine modified release SR
Labetalol IV
Hydralazine IV

19
Q

Contraindications for labetalol

A

Asthma

Type 1 diabetics - masks palpitations with hypo

20
Q

Side effects of labetalol

A

Scalp tingling
Headache
GI disturbance
Liver damage

21
Q

When do you need to stop methyldopa for hypertension in pregnancy

A

Within 2 days of delivery as increased risk of post natal depression

22
Q

Why do you need to treat hypertension in pregnancy

A

Increased risk of haemorrhagic stroke

23
Q

Post natal monitoring of hypertension

A

For 5 days after delivery

Medical review 2 weeks after delivery at GP to see if medication needs continuing

24
Q

What is HELLP syndrome

A

Activation of clotting cascade causing:
Haemolysis
Elevated liver enzymes
Low platelets <150

25
Q

Management of HELLP syndrome

A

Treat by delivering baby once mother stable <48 hours
Give mother corticosteroids x2 24 hours apart
Can transfuse blood products as needed

26
Q

Fetal risks of HELLP syndrome

A 
Prematurity 
Stillbirth
Neonatal death
Placental abruption
Placental failure
27
Q

Dosage of labetalol

A

100mg BD starting dose
Can increase every 2 weeks by 200mg if needed
Maximum dose of 2400mg per day

28
Q

Risk factors for preeclampsia

A 
>40 years old
Nulliparous
>10 years since last pregnancy
Multiple pregnancy 
FH or PH
Chronic hypertension
Chronic renal disease
29
Q

Recurrence rate of eclampsia

A

10%

30
Q

Management of chronic hypertension in pregnancy

A

Serial fetal growth charts to monitor
Continue BP medication except for ACEi and diuretics
Aim to deliver by 40 weeks

31
Q

When to deliver in preeclampsia

A

Mild - >36 weeks

Severe - asap regardless of gestational age unless proteinuria >5g/24hrs only criteria fulfilled

32
Q

When is IV MgSO4 given

A

IV intrapartum for severe preeclampsia continued for at least 24 hours post partum

33
Q

Pathophysiology of eclampsia

A

Cerebral oedema

Hypertensive encephalopathy

34
Q

What commonly used drugs in labour are contraindicated in preeclampsia

A

Ergometrin

Syntometrin

35
Q

Indications for urgent delivery I.e severe preeclampsia

A 
Worsening thrombocytopenia
Worsening liver function 
Worsening kidney function
Fetal distress
Eclampsia
HELLP syndrome

Obs & Gynae (37 decks)

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