Pre-eclampsia Flashcards
What is pre-eclampsia defined as
HTN and proteinuria in pregnancy
What is the definition of hypertension during pregnancy?
• systolic > 140 mmHg or diastolic > 90 mmHg
or
increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic
What is the pathophysiology of pre-eclampsia?
- 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)
When does pre-clampsia develop and resolve?
after 20 weeks
then within 6 weeks of delivery
What are high risks of developing pre-eclampsia?
• Prev. severe or early onset pre-eclampsia • Chronic HTN or HTN in prev. pregnancy • CKD • DM Autoimmune disease
What are moderate risk factors of pre-eclampsia?
• 1st pregnancy • >40 • FHx • Multiple pregnancy • Pregnancy interval >10y • BMI >30 • Low PAPP-A Uterine artery notching on Doppler US at 22-24w
What are fetal RFs for developing pre-eclampsia?
- Hydatidiform mole
- Multiple pregnancy
- Fetal hydrops
When is the criteria for giving aspirin? when should it be given and what dose
1 high risk or 2 mod risk = ASPIRIN 75mg/24hr from 12 weeks
What are the effects of pre-eclampsia?
♣ Plasma volume ♣ peripheral resistance ♣ placental ischaemia ♣ >180/140mmHg leads to micro aneurysms in arteries ♣ DIC ♣ Oedema suddenly
What are severe complications of pre-eclampsia?
- Eclampsia
- HELLP syndrome
- Cerebral haemorrhage
- IUGR
- Renal failure
- Placental abruption
What are the sx of pre-eclampsia?
− Severe headaches − Visual problems - blurred vision, flashing lights, diplopia, floating spots − Vomiting − Breathlessness − Sudden oedema of face, hands or feet
What are signs of pre-eclampsia?
→ Pregnancy induced HTN → Proteinuria → Epigastric, RUQ tenderness → Brisk reflexes → >2 beats of clonus → Confusion → Fits → Placental abruption → IUGR → Stillbirth
What are Ix for pre-eclampsia?
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
What is the management of mild pre-eclampsia?
- 4 hrly BP
- x2 weekly bloods to monitor renal function, LFTs, FBC
- Fetal growth scans every 2 weeks
- Induce after 37/40
Admit hospital
What is the management of mod pre-eclampsia?
- Admit to hosp until delivery
- 4 hrly BP
- x3 weekly bloods
- Fetal growth scans every 2w
- X2 daily CTG
- Start antihypertensives
Aim for IOL at 37/40
What is the management of severe pre-eclampsia?
- Stabilise BP w antihypertensives e.g. nifedipine
- IV labetalol or hydralazine if this fails
- Prophylactic MgSO4
- Give steroids for fetal lung maturity
What is severe pre-eclampsia classed as?
BP: >160/110mmHg OR sx of end-organ damage
What is eclampsia classed as?
tonic clonic seizure + pre-eclampsia
What are causes of mortality in eclampsia?
HELLP
Cerebral haemorrhage
organ failure
What is the management of eclampsia
ABC, IV access Continuous sats + BP MgSO4 Diazepam restrict fluids to 80ml.hr CTG Deliver once mum stable w LSCS
Why is magnesium sulphate given in eclampsia?
to prevent and treat seizures
Why is Diazepam given in eclampsia?
to treat repeated seizures
When should magnesium sulphate be stopped in eclampsia?
if RR <12/min
Tendon reflex lost
UO <20ml/hr
How is MgSO4 toxicity treated?
IV calcium gluconate
What ix should be undertaken in eclampsia?
FBC U&E LFTs creatinine clotting studies every 12-24h
What is the management of the third stage of labour
oxytocin
What is the treatment of HTN in pregnancy?
Labetalol or hydrazine
What is 1st line antihypertensive for pre-eclampsia in women w asthma?
nifedipine NOT labetalol or hydralazine
What is mild HTN in pregnancy classed as?
140-149/90-99
What is moderate HTN in pregnancy classed as?
150-159/100-109
What is severe HTN in pregnancy classed as?
> 160/110
What is the difference between chronic HTN, gestational HTN and pre-eclampsia?
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
What is normal physiological changes in BP in pregnancy?
Falls in 1st and 2nd trimester and rises to pre-pregnancy levels by term
What is significant proteinuria?
> 300mg of protein in 24 hr urine collection
>30mg/mmol in PCR
What symptoms should prompt medical attention in pre-eclampsia
severe headaches vision problems persisting epigastric pain or RUQ pain vomiting breathlessness sudden swelling of hands, feet or face
If a pregnant woman w chronic HTN is already on ACEi during pregnancy, what should be done?
Stop ACEi and prescribe labetalol
What BP should be aimed for w uncomplicated HTN
150/100-80
What BP should be aimed for w complicated HTN (end organ damage)
140/90
When should birth be offered <34 weeks?
If severe HTN develops refractory to treatment
When should birth be offered after 34 weeks?
if severe: controlled BP and course of CS has been given
if mild-mod: 34-36+6 weeks
When should birth be offered within 24-48hrs?
mild to moderate HTN after 37 weeks
What is HELLP syndrome
Haemolysis
Elevated Liver Enzymes
Low platelets
What is the cure for HELLP
Delivery
What are the sx of HELLP
- Epigastric/RUQ pain
- N&V
- Dark urine - due to haemolysis
- Increased BP
