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Pre-eclampsia Flashcards

1
Q

What is pre-eclampsia?

A

Pregnancy induced hypertension in association with proteinuria (>0.3g in 24 hours)

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2
Q

Why is pre-eclampsia important?

A

It is relatively common but can become life-threatening for mother and fetus

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3
Q

What is severe pre-eclampsia?

A

BP of ≥160/110 mmHg and/or symptoms and/or biochemical and/or haematology impairment

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4
Q

What is eclampsia?

A

The occurence of one or more convulsions superimposed on pre-eclampsia

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5
Q

What % of pregnancies in the UK are affected by pre-eclampsia?

A

6%

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6
Q

How dangerous are severe pre-eclampsia and eclampsia?

A

They are the second most common cause of direct maternal death in the UK

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7
Q

What proportion of pregnancies are affected by severe pre-eclampsia?

A

5/1000

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8
Q

What proportion of pregnancies are affected by eclampsia?

A

5/10,000

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9
Q

What proportion of stillbirths with no congenital abnormalities occur in women with pre-eclampsia?

A

20%

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10
Q

What proportion of women with severe pre-eclampsia deliver before 36 weeks?

A

50%

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11
Q

What is the common thought of what causes pre-eclampsia?

A

Poor placental perfusion due to abnormal placentation

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12
Q

What happens in normal placentation?

A

The trophoblast invades the myometrium and the spiral arteries, destroying the tunica muscularis media, rendering spiral arteries dilated and unable to constrict.

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13
Q

What is the result of normal placentation?

A

Provides pregnancy with a high flow, low resistance circulation

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14
Q

How is the remodelling of spiral arteries different in pre-eclampsia?

A

They are incompletely re-modelled

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15
Q

What is the result of incomplete spiral artery re-modelling in pre-eclampsia?

A

Development of a high resistance, low-flow uteroplacental circulation develops as the constrictive muscular walls of the spiral arterioles is maintained

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16
Q

How does the high resistance, low flow uteroplacental circulationof pre-eclampsia affect BP?

A

Causes an inccrease

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17
Q

What other pathophysiological factors are caused by inadequate uteroplacental perfusion in pre-eclampsia?

A

Hypoxia and oxidative stress

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18
Q

What is caused by the raised BP, hypoxia and oxidative stress caused by pre-eclampsia?

A

Systemic inflammatory response and endothelial cell dysfunction (resulting in leaky blood vessels)

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19
Q

What factors put women at high risk of pre-eclampsia?

A
  • Previous pre-eclampsia
  • Previous eclampsia
  • Previous hypertension in pregnancy
  • Pre-existing hypertension
  • Pre-existing CKD
  • Pre-existing diabetes
  • SLE
  • Antiphospholipid syndrome
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20
Q

What factors put women at moderate risk of pre-eclampsia?

A
  • 10 years or more since last pregnancy
  • First pregnancy
  • Age 40 or more
  • BMI >35 at presentation
  • Family history
  • Multiple pregnancy
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21
Q

What criteria should be met to be diagnosed with pre-eclampsia?

A
  • Hypertension
  • Significant proteinuria
  • > 20 weeks gestation
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22
Q

What is classified as hypertension fulfilling the criteria of pre-eclampsia?

A

BP >140/90 mmHg on 2 occasions >4 hours apart

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23
Q

What is classified as significant proteinuria, fulfilling the criteria of pre-eclampsia?

A

> 300mg protein in a 24 hour urine sample or >30mg/mmol urinary protein:creatinine

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24
Q

Is the presentation of pre-eclampsia the same in everyone?

A

No

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25
Why should proteinuria and hypertension be checked for at every antenatal appointment?
Some people with pre-eclampsia are asymptomatic
26
What are some possible clinical features of pre-eclampsia?
- Headaches - Visual disturbance - Epigastric pain - Sudden onset non-dependent odema - Hyper-reflexia
27
What visual disturbances can occur in pre-eclampsia?
- Blurred or double vision - Halos - Flashing lights
28
Where do pre-eclampsia headaches usually occur?
Frontal
29
What BP range is mild pre-eclampsia?
140-149/90-99 mmHg
30
What BP range is moderate pre-eclampsia?
150-159/100-109 mmHg
31
What is severe pre-eclampsia?
>160/100 mmHg AND proteinuria OR >140/90mmHg, proteinuria and symptoms
32
What are the differentials for pre-eclampsia?
- Essential HTN - Pregnancy induced HTN - Eclampsia
33
What is essential HTN?
HTN prior to 20 weeks gestation
34
What is pregnancy induced HTN?
New onset HTN after 20 weeks without proteinuria
35
What is eclampsia?
Pre-eclampsia and seizures
36
What investigations should be done for pre-eclampsia?
- Urinalysis - Blood tests - Clotting studies - 24 hour urine collection for protein quantification and creatinine clearance - Assessment of fetus
37
What analysis should urine undergo in suspected pre-eclampsia if protein is present?
- Microscopy - Culture - Sensitivty
38
What blood tests should be ordered in assessment of pre-eclampsia?
- FBC - LFT - Renal function - Serum urea
39
How should the fetus be assessed in suspected pre-eclampsia?
- Ultrasound assessment of fetal growth - Volume of amniotic fluid - Umbilical artery doppler
40
When should a woman with suspected pre-eclampsia be admitted straight to hospital?
- > 1+ protein OR | - >30mg/mmol spot urea:creatinine
41
Whys should women with certain protein or spot protein:creatine be admitted straight to hospital?
They are over the dividing line between minimal and significant risk to mother and baby
42
What are the aims of management in pre-eclampsia?
- Prevent development of eclampsia | - Minimise the risk of complications for mother and fetus
43
What plays a large part in management of pre-eclampsia?
Monitoring of maternal and fetal wellbeing
44
How can maternal and fetal wellbeing monitoring be achieved in pre-eclampsia?
- Regular BP measurements - Urinalysis - Blood tests - Fetal growth scans - Cardiotocography
45
As a rule what is the degree and frequency of monitoring in pre-eclampsia correlated with?
Severity of disease
46
What are some other potential management points for pre-eclampsia?
- VTE prevention - Anti-hypertensives - Delivery
47
Why is VTE prevention an important consideration in the management of pre-eclampsia?
Most women are managed as inpatients and require fluid management and VTE prophylaxis
48
What is the most commonly used agent for VTE prevention in pre-eclampsia?
LMWH
49
Why are anti-hypertensives used in pre-eclampsia?
Reduce the risk of maternal haemorrhagic stroke
50
Do antihypertensives help to alter the course of pre-eclampsia?
No
51
What is the only definitive cure for pre-eclampsia?
Delivery of the baby
52
What should influence the decision of how and when to deliver in pre-eclampsia?
Health of mother and fetus
53
Who does prolonging pregnancy in pre-eclampsia benefit?
Only the fetus
54
What should be given if delivery is to occur before 35 weeks gestation for pre-eclampsia?
IM steroids
55
Why are IM steroids used for early delivery in pre-eclampsia?
to aid development of fetal lungs
56
When does pre-eclampsia resolve?
After delivery of the placenta
57
How long should the mother be monitored for post-partum in pre-eclampsia?
24 hours
58
Why should the mother have monitoring for 24 hours post-partum in pre-eclampsia?
They are still at risk of having eclamptic seizures
59
When can women with pre-eclampsia be considered safe after delivery?
Day 5
60
How long should BP be monitored for after delivery in pre-eclampsia?
Daily for first 2 days then at least once 3-5 days post-partum
61
Should women stay on anti-hypertensives after pre-eclampsia?
The need should be re-assessed
62
What should women be warned of in the future following pre-eclampsia?
Risk of developing pre-eclampsia or gestational induced hypertension in future pregnancies
63
What feature of pre-eclampsia is associated with a poorer prognosis for the development of complications?
Onset before 34 weeks
64
What are the maternal complications of pre-eclampsia?
- HELLP syndrome - Eclampsia - AKI - DIC - ARDS - Post-partum hypertension - Cerebrovascular damage
65
What are the major fetal complications of pre-eclampsia?
- Prematurity - IUGR - Placental abruption - Intrauterine fetal death
66
How can pre-eclampsia and its complications be prevented?
- Identify women with known risk factors at booking - Early recognition and action against symptoms - Antiplatelet agents - Calcium supplementation in pregnancy
67
What antiplatelet agent is often used to reduce the risk of pre-eclampsia?
Low dose aspirin
68
What is NICE's recommended dose of aspirin for prevention of pre-eclampsia?
75mg from 12 weeks to women at high risk or 2 moderate risk factors

Obstetrics (61 decks)

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