pre-eclampsia Flashcards
What is the pathophysiology of pre-eclampsia?
The spiral arteries fail to dilate as normal and become vascular sinuses. That means there is less oxygen for the fetus and so the hypo perfused placenta releases pro-inflammatory proteins that cause vasoconstriction and kidney dysfunction in the mother
Which maternal organs are affected by pre-eclampsia and how?
- kidney: GFR and renal blood flow decreases, raised uric acid, proteinuria, hypocalciuric, suppression RAAS
- coagulation: thrombocytopenia (as platelets form thrombi due to endothelial damage from pro-inflammatory proteins), higher fibronectin
- Liver: HELLP
- brain- cerebral oedema
- retinopathy
What are the risk factors for pre-eclampsia?
35 years or older Fhx obesity BME Primigravity Diabetes CKD Htn pre-existing Renal disease Collagen vascular disease eg SLE, antiphospholipid Multifetal pregnancy
What are the different types of hypertension in pregnancy and explain them?
chronic htn - existed before pregnancy OR developed before the 20th gesttaional week OR developed during pregnancy and didn’t resolve after
gestational htn- new after the 20th week with little proteinuria (may go on to get pre-eclampsia)
pre-eclampsia- new after the 20th week with proteinuria (+2 urine dip- as marker of kidney damage)
What ix can be used to rule out pre-eclampsia?
The NICE guidelines (2019) recommend the use of placental growth factor (PlGF) testing on one occasion during pregnancy in women suspected of having pre-eclampsia. Placental growth factor is a protein released by the placenta that functions to stimulate the development of new blood vessels. In pre-eclampsia, the levels of PlGF are low. NICE recommends using PlGF between 20 and 35 weeks gestation to rule-out pre-eclampsia.
What is the criteria for severe pre-eclampsia?
160/110mmHg >5g proteinuria/ +3 urine dipstick oliguria (400mls in 24 hrs) CNS symptoms pulmonary oedema epigastric/ RUQ pain Impaired LFTs thrombocytopenia intrauterine growth restriction oligohydramnios (low amniotic fluid)
What is eclampsia?
generalised tonic clonic seizure plus pre-eclampsia
What are the investigations for pre-eclampsia?
ambulatory blood pressure monitoring urine dip umbiblical artery doppler Dating and assessing of foetal growth Blds (FBC (hb and platelets), U&Es (uric acid), LFTs)
What might you find on eamination for pre-eclampsia?
epigastric/RUQ pain due to liver HELP retinal oedema ankle clonus pitting oedema loss visual acuity
What symptoms do you get with pre-eclampsia?
Symptoms: CNS sx- visual changes, headache, scotomata (temporary loss visual acuity in part of vision) mental state changes abdo pain oedema rapid weight gain SEIZURES
What are the differentials for pre-eclampsia?
TTP
Haemolytic uremic syndrome
Acute fatty liver of pregnancy
What is the management for pre-eclampsia?
Monitoring: aim 135/85; admit if 160/110, urine dip twice a week, bloods weekly, fetal growth
Labetolol is first-line as an antihypertensive
Nifedipine (modified-release) is commonly used second-line
Methyldopa is used third-line (needs to be stopped within two days of birth)
Intravenous hydralazine may be used as an antihypertensive in critical care in severe pre-eclampsia or eclampsia
IV magnesium sulphate is given during labour and in the 24 hours afterwards to prevent seizures
Fluid restriction is used during labour in severe pre-eclampsia or eclampsia, to avoid fluid overload
What can the complications be of pre-eclampsia?
Haemorrhagic stroke Placental abruption ARDS Multi organ failure prematurity
What is HELLP syndrome?
HELLP syndrome is a complication of pregnancy characterized by hemolysis, elevated liver enzymes, and a low platelet count.
Symptoms may include feeling tired, retaining fluid, headache, nausea, upper right abdominal pain, blurry vision, nosebleeds, and seizures. Complications may include disseminated intravascular coagulation, placental abruption, and kidney failure
