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Obstetrics > Pre-eclampsia > Flashcards

Pre-eclampsia Flashcards

1
Q

What is pre-eclampsia defined as

A

HTN and proteinuria in pregnancy

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2
Q

What is the definition of hypertension during pregnancy?

A

• systolic > 140 mmHg or diastolic > 90 mmHg
or
increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic

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3
Q

What is the pathophysiology of pre-eclampsia?

A
  • Multi-system disorder originating from the placenta
  • Failure of trophoblastic invasion of spiral arteries leaving them vasoactive - if they properly invade then they cannot clamp down in response to vasoconstrictors and this protects placental flow
  • Increasing BP partially compensates for this but with systemic consequences (hepatic, renal, coagulation)
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4
Q

When does pre-clampsia develop and resolve?

A

after 20 weeks

then within 6 weeks of delivery

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5
Q

What are high risks of developing pre-eclampsia?

A 
•	Prev. severe or early onset pre-eclampsia
•	Chronic HTN or HTN in prev. pregnancy
•	CKD
•	DM
Autoimmune disease
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6
Q

What are moderate risk factors of pre-eclampsia?

A 
•	1st pregnancy 
•	>40
•	FHx 
•	Multiple pregnancy 
•	Pregnancy interval >10y
•	BMI >30
•	Low PAPP-A
Uterine artery notching on Doppler US at 22-24w
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7
Q

What are fetal RFs for developing pre-eclampsia?

A
  • Hydatidiform mole
  • Multiple pregnancy
  • Fetal hydrops
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8
Q

When is the criteria for giving aspirin? when should it be given and what dose

A

1 high risk or 2 mod risk = ASPIRIN 75mg/24hr from 12 weeks

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9
Q

What are the effects of pre-eclampsia?

A 
♣	Plasma volume 
♣	 peripheral resistance
♣	placental ischaemia
♣	>180/140mmHg leads to micro aneurysms in arteries
♣	DIC
♣	Oedema suddenly
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10
Q

What are severe complications of pre-eclampsia?

A
  • Eclampsia
  • HELLP syndrome
  • Cerebral haemorrhage
  • IUGR
  • Renal failure
  • Placental abruption
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11
Q

What are the sx of pre-eclampsia?

A 
−	Severe headaches 
−	Visual problems - blurred vision, flashing lights, diplopia, floating spots
−	Vomiting 
−	Breathlessness
−	Sudden oedema of face, hands or feet
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12
Q

What are signs of pre-eclampsia?

A 
→	Pregnancy induced HTN
→	Proteinuria
→	Epigastric, RUQ tenderness
→	Brisk reflexes
→	>2 beats of clonus
→	Confusion 
→	Fits
→	Placental abruption
→	IUGR
→	Stillbirth
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13
Q

What are Ix for pre-eclampsia?

A 
Protein creatinine ratio >30mg/mmol
Thrombocytopenia
Raised serum uric acid
Prolonged APTT and PT
Raised creatinine
Anaemia 
Abnormal LFTs
FGR, oligohydramniois
notching of uterine arteries on doppler US, abnormal umbilical arteries on doppler uS
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14
Q

What is the management of mild pre-eclampsia?

A
  1. 4 hrly BP
  2. x2 weekly bloods to monitor renal function, LFTs, FBC
  3. Fetal growth scans every 2 weeks
  4. Induce after 37/40
    Admit hospital
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15
Q

What is the management of mod pre-eclampsia?

A
  1. Admit to hosp until delivery
  2. 4 hrly BP
  3. x3 weekly bloods
  4. Fetal growth scans every 2w
  5. X2 daily CTG
  6. Start antihypertensives
    Aim for IOL at 37/40
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16
Q

What is the management of severe pre-eclampsia?

A
  1. Stabilise BP w antihypertensives e.g. nifedipine
  2. IV labetalol or hydralazine if this fails
  3. Prophylactic MgSO4
  4. Give steroids for fetal lung maturity
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17
Q

What is severe pre-eclampsia classed as?

A

BP: >160/110mmHg OR sx of end-organ damage

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18
Q

What is eclampsia classed as?

A

tonic clonic seizure + pre-eclampsia

19
Q

What are causes of mortality in eclampsia?

A

HELLP
Cerebral haemorrhage
organ failure

20
Q

What is the management of eclampsia

A 
ABC, IV access
Continuous sats + BP 
MgSO4 
Diazepam 
restrict fluids to 80ml.hr
CTG
Deliver once mum stable w LSCS
21
Q

Why is magnesium sulphate given in eclampsia?

A

to prevent and treat seizures

22
Q

Why is Diazepam given in eclampsia?

A

to treat repeated seizures

23
Q

When should magnesium sulphate be stopped in eclampsia?

A

if RR <12/min
Tendon reflex lost
UO <20ml/hr

24
Q

How is MgSO4 toxicity treated?

A

IV calcium gluconate

25
Q

What ix should be undertaken in eclampsia?

A 
FBC
U&amp;E
LFTs
creatinine
clotting studies every 12-24h
26
Q

What is the management of the third stage of labour

A

oxytocin

27
Q

What is the treatment of HTN in pregnancy?

A

Labetalol or hydrazine

28
Q

What is 1st line antihypertensive for pre-eclampsia in women w asthma?

A

nifedipine NOT labetalol or hydralazine

29
Q

What is mild HTN in pregnancy classed as?

A

140-149/90-99

30
Q

What is moderate HTN in pregnancy classed as?

A

150-159/100-109

31
Q

What is severe HTN in pregnancy classed as?

A

> 160/110

32
Q

What is the difference between chronic HTN, gestational HTN and pre-eclampsia?

A

chronic HTN is HTN present before 20 weeks
Gestational HTN is HTN presenting after 20 weeks but w no proteinuria
pre-eclampsia is HTn and proteinuria after 20 weeks

33
Q

What is normal physiological changes in BP in pregnancy?

A

Falls in 1st and 2nd trimester and rises to pre-pregnancy levels by term

34
Q

What is significant proteinuria?

A

> 300mg of protein in 24 hr urine collection

>30mg/mmol in PCR

35
Q

What symptoms should prompt medical attention in pre-eclampsia

A 
severe headaches
vision problems
persisting epigastric pain or RUQ pain
vomiting
breathlessness
sudden swelling of hands, feet or face
36
Q

If a pregnant woman w chronic HTN is already on ACEi during pregnancy, what should be done?

A

Stop ACEi and prescribe labetalol

37
Q

What BP should be aimed for w uncomplicated HTN

A

150/100-80

38
Q

What BP should be aimed for w complicated HTN (end organ damage)

A

140/90

39
Q

When should birth be offered <34 weeks?

A

If severe HTN develops refractory to treatment

40
Q

When should birth be offered after 34 weeks?

A

if severe: controlled BP and course of CS has been given

if mild-mod: 34-36+6 weeks

41
Q

When should birth be offered within 24-48hrs?

A

mild to moderate HTN after 37 weeks

42
Q

What is HELLP syndrome

A

Haemolysis
Elevated Liver Enzymes
Low platelets

43
Q

What is the cure for HELLP

A

Delivery

44
Q

What are the sx of HELLP

A
  • Epigastric/RUQ pain
  • N&V
  • Dark urine - due to haemolysis
  • Increased BP

Obstetrics (30 decks)

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