Pre-eclampsia Flashcards
What is pre-eclampsia?
Hypertension and proteinuria (>0.3g/24h) in pregnancy
Multisystem disorder originating in the placenta
What is the pathophysiology of pre-eclampsia?
Failure of trophoblastic invasion of spiral arteries leaving them vasoactive.
When properly invaded they cannot clamp own in response to vasoconstrictors and this protects placental flow.
Increasing BP initially compensates for this.
Also affects hepatic, renal and coagulation systems
When does pre-eclampsia occur?
Develops after 20 weeks and resolves within 6 weeks of delivery
What problems does pre-eclampsia predispose to?
Maternal morbidity (from cerebral haemorrhage, multi-organ failure and adult respiratory distress)
Fetal: prematurity, intrauterine growth restriction
Eclampsia
Haemorrhage: placental abruption, intra-abdominal, intra-cerebral
Cardiac failure
multi-organ failure
What are high risk factors for pre-eclampsia? How should you manage these?
Previous severe or early onset pre-eclampsia (<20 weeks)
Chronic hypertension
Hypertension in previous pregnancy
CKD
DM
Autoimmune disease - SLE, antiphospholipid syndrome
If 1 high risk factor, take aspirin 75 daily from 12th week until delivery to prevent.
What are moderate and fetal risk factors for pre-eclampsia?
Moderate: First preganncy >40 yo Pregnancy interval > 10 years BMI>30 FHx of pre-eclampsia Multiple pregnancy Low PAPP-A
If 2 moderate risk factors take aspirin 75 daily from 12th week to prevent
Fetal:
Hyatidform mole, multiple pregnancy, fetal hydros (e.g. rhesus disease)
What are the effects of pre-eclampsia?
Reduced plasma volume
Increased peripheral resistance
Placental ischaemia
If BP>180/140 micro aneurysms develop in arteries
DIC may develop
Oedema may develop suddenly
Liver may be involved
What are complications of pre-eclampsia?
Eclampsia HELLP syndrome Cerebral haemorrhage IUGR REnal failure Placental abruption Oligohydramnios due to reduced perfusion of the placenta
What are symptoms and signs of pre-eclampsia?
Symptoms Headache Flashing lights/visual disturbance Epigastric or RUQ pain N/V Swelling of face, fingers and lower limbs
Signs: HTN typically >170/110 Proteinuria ++/+++ on dipstick Epigastric or RUQ tenderness Hyperreflexia Fits Confusion
What investigations in pre-eclampsia?
Protein-creatinine ratio > 30mg/mmol Raised serum uric acid Thrombocytopenia anaemia if haemolysis (LDH raised) Abnormal LFTs Fetal growth restriction Oligohydramnios Notching of uterine arteries on Doppler Abnormal umbilical artery Doppler
What is mild, moderate and severe pre-eclampsia?
Mild:
BP 140-149/90-99
PCT > 30mg/mmol
Moderate
BP 150-159/100-109
Severe
BP>160/110 or symptoms/signs of end-organ damage
What is management for mild pre-eclampsa?
Twice weekly bloods to monitor renal function, LFTs, FBC
Fetal growth scan every 2 weeks
Do not start antihypertensives unless BP>150/100
Induction of Labour after 37/40
What is management for moderate pre-eclampsia?
Admit to hospital until delivery
Bloods 3 times per week
2 weekly fetal growth scan
Twice daily CTG
Start oral labetalol
Nifedipine and hydrazine may also be used
IOL at 37/40
What is management for severe pre-eclampsia?
Stabilise BP with antihypertensives
E.g. nifedipine 10mg PO twice 30 min apart
IF BP remains high start IV labetalol
Bloods every 12-24h
Prophylactic magnesium sulphate 4g IV loading dose then 1g IV/hour.
Stricy fluid balance
Steroids for fetal lung maturity and if > 34 weeks, deliver
Deliver within 24-48h if women < 34 weeks
What is eclampsia?
Tonic-clonic seizure + pre-eclampsia (after 20 weeks hypertension and proteinuria)
