Pre eclampsia Flashcards
What is the Aetiology of Pre Eclampsia
Endothelial cell dysfunction due to poor placental implantation.
What does the Endothelial cell dysfunction cause
Leads to vasoconstriction that causes hypertension and high vascular permeability. (Oedema).
Increase permeability destructs the kidneys from preventing them to filter therefore protein is not filtered and can be seen in the urine.
Symptoms
Headaches
Visual Disturbances
seizures - All caused by the hypertension and thrombusformation
Liver damage - liver swelling nausea vomiting right upper quadrant pain
Oedema to face hands and feet due to the high permeability.
Hypertension -150/100
Risk factors
High - Pre existing diabetes, Chronic Hypertension, chronic kidney disease , previous pregnancy with hypertension, auto immune diseases
Moderate- Maternal age, primip, multiple pregnancies, bmi above 35 and family history.
Maternal complications
Renal and liver failure brain bleeds DIC Seizures Thrombocytopenia Anemia VTE Death
Fetal Complications
IUGR
PREM
IUD
Abruption
Management Antenatal
Bloods- FBC, LFT'S UNE'S, measured 2-3 times a week. BP checks- 150/100 Labetelol Aspirin after 12 weeks USS- Growth Cortosterioids for below 34 weeks TEDS Physiological support
Management Intrapartum
Hourly BP Anti hypertensives Avoid Syntometrine or ergometrine due to the rise in BP however risk benefit. Potential CS - at least 34 weeks Consider epidural because it lowers BP Bloods
Management Postnatal
Continue Anti hypertensives untill BP is below 130/80 Repeat bloods 48-72 hours GP meds review Obs review at 6 weeks BP check days 3-5
Severe Pre Eclampsia
160/110 on more than two occassions and proteinunriea
- Blood pressure control
Oral or IV labetelol
- Fluid Management
Fluid restriction, 1ml per KG per hour
- Prevention of seizures
Magnesium Sulphate as it relaxes smooth muscle activity
Loading Dose 4g in 20mls IV 5-10 minutes
Maintenance dose 1g/1hour 24 hours
- Control of seizures
Further Bolus of 2g Iv.
