Pre-Eclampsia Flashcards
Degrees of pre-eclampsia
Follows HTN
Mild: 140/90-149/99
Mod: 150/100-159/109
Severe: 160/110
Admit to hospital for pre-eclapmsia
Mild
Mod
Severe
Treat Pre-eclampsia?
Mild: no
Moderate: oral labetalol (150/80-100)
Severe: PO labetalo (150/80-100)
Measure BP in pre-eclampsia
mild: 4+/day
Mod: 4+/day
Severe: >4 depends on circumstances
Test for proteinuria in pre-eclampsia
Mild: no need to repeat quantification of proteinuria
Moderate: do not repeat quantification of proteinuria
Severe: do not repeat quantification of proteinuria
Blood test in pre-eclampsia
Kidney fucntion
electrolytes
FBC
LFT + bili
Mild 2/wk
mod/sev: 3/wk
Diagnosis of pre-eclampsia
BP >140/90
Proteinuria (PCR >30)
Antenatal Mx of Pre-eclampsia
Treat htn: Labetalol (nifedipine/methyldopa) 2nd line: hydralazine, amlodipine, doxazocin
Regular foetal surveillence (growth, liquor, UA doppler)
Steroids if delivery <34 weeks
do NOT deliver unless mother stable
avg. Dx to delivery = 2 weeks
Fetal Monitoring in Pre-eclampsia
Growth scans and UA dopplers (PET)
Mild/mod GHTN: USS FG, amnio vol., UA doppler if Dx <34wks, CTG only if abnormal. 15% will -> pre-eclampsia
Severe GHTN or Pre-eclampsia:
- CTG at Dx, if normal 1 weekly, repeat if:
- RFM, PVB, Abdo pn, det. maternal condition
- if planning conservative Mx then just fo USS FG, AFVA, UADV
High risk of Pre-eclampsia:
- USS F, AFVA, UADV at 28-30wks
repeat 4 weeks later if:
- Hx: severe pre-eclampsia, PE req. birth <34wk, PE w/SGA, IU death, abruption
PET
Pre-eclamptic toxaemia
Cx of pre-eclampsia
Bilateral notching and increased pulsatility index at 24wks predicts PET
Timing of birth in Pre-eclampsia
Manage conservatively until 34wk
Offer birth to pts w/PE <34wks and after CS if:
- severe refractory HTN, indications
Recommend birth to pts w/PE + sev. HTN once BP controlled
Offer to pt w/mild/mod PE at 34-34+6
Recommend birth within 24/48hrs for women w/PE and mild/mod htn after 37wk
Indications for delivery in pre-eclampsia
Uncontrollable BP
Rapidly worsening biochem/haematology
Eclampsia
Maternal Sx
Foetal distress (sev. IUGR/ red. UA EDF
Intrpartum care in pre-eclampsia
Continuous CTG
Regional anaesthesia helps control BP
Operative birth if refractory HTN
AVOID ergometrine
BP measurements hourly if mild/mod, cont. if sev.
Continue antenatal anti-htn
do NOT routinely limit the duration of second stage in women:
-mild/mod htn or sev. in target range
Medical Mx of Severe HTN or pre-eclampsia in critical care setting
IV MgSO4 given to pt. w/ sev htn/PE who has Hx eclamptic fit
Consider MgSO4 in critical care if birth <24hrs
Continue MgSO4 for 24hrs after last seizure or following delivery
MgSO4 Risk, counter?
Features of Severe pre-Eclampsia
Sev. htn and proteinuria
Mild/mod htn AND one of:
- severe headache, visual disturbance, papilloedema
- Severe pain below the ribs
- clonus
- Liver tenderness
- HELPP
- plts <100
- abnormal LFT
Dosing of MgSO4 in severe htn/PE in critical care
loading 4g IV/5mins
infusion 1g/hr 24hrs
Recurrent seizure: 2-4g/5min
Monitor: urine output, reflexes, RR, O2 sats
Mx Women w/severe htn in critical care during pregnancy or after birth immediately with:
Labetalol PO/IV
Hydralaine (IV)
Nifedipine PO
Response to treatment with anti-htn after birth in women with severe htn in a critical care setting
Ensure BP dalls
Identify adverse effects
Modify treatment
If pt. in critical care w/sev htn what to consider if delivery likely <36 weeks
betamethasone
Postnatal investigation, monitoring and treatment for pre-eclampsia
BP: 4/d as in-pt., once d3-5, then alternate days until normal
Commence anti-htn if >150/100
Ask about sev. headache and epigastric pn when BP measured
Pts who took anti-htn and gave birth: continue, consider reduce if <140/90, reduce if <130/80
Stop methyldopa 2d after birth
Transfer to community care after pre-eclampsia
No Sx of PE
BP <149/99
Bloods stable/improving
Care plan: freqency of BP monitoring, threshold for red/stop Rx, indications for referral, self monitoring
Medical review if still on anti-htn 2wks after community transfer
Breastfeeding in pre-eclampsia
Avoid duiretics while bf/expressing
Not recommened: ARB, ACEi (2 exceptions), amlodipine
Safe: labetalol, nifedipine, enalaprin, captopril, atenalol, metoprolol
Advice and FU care for pre-eclampsia
GHTN and PE increase risk of mother getting HTN later
Increased RR of kidney dx but risk small if no proteinuria/htn at 6-8wk review
Risk in future pregnancies if GHTN
GHTN 16-47%
PE 2-7%
Risk in future pregnancies if a woman had PE
GHTN: 13-53%
PE: 16% (higher if sev./HELLP)
Antenatal summary for PE
- Treat HTN (labetalol, nifedipine, methyldopa)
- Regular surveillance (growth, liqour, UA, blood flow)
- Steroids if delivery <34wk
- do NOT deliver unless mother stable
Severe PE summary
Transfer HDU unless in active labour
stop anit-coag
inform: labour ward coord, consultant obs., anaesthetist
MEOWS/HDU chart BP every 15min
PET bloods 4-12hrly
Postnatal sumary for Pre-eclampsia
If severe PET observe in HDU for 24hr (fluid, BP, symptoms)
consider LMWH within 6hr delivery
BP may peak at d3-6
avoid NSAIDs
BP Rx: atenolol, nifedipine, amlodipine
Recurrence: 15% riskon average
PACES Counselling of Pre-eclampsia
RF: Hx (G)HTN, multiple preg., DM, kidney dx, first pregnancy, obesity, ><20>35, FHx, PCOS
Admission required until BP controlled
Risks: early del., reduced placental func., IUGR, risk to mother)
2-8% of pregnancies
Rx: labetalol
BP closely monitored: 4/d then 2/3 per week
Early delivery may be necessary
Once discharged: BP+CTG 2/wk and bloods
Risk of recurrence 15%
