Pre-Eclampsia

Question 1

What are the major and moderate risk factors for pre-eclampsia ?

Answer 1

Major ( at least 1) :
history of pre-eclampsia .
Multi-fetal gestation .
Autoimmune disease .
DM type 1 & 2.
Chronic hypertension .
Renal disease .

Moderate ( at least 2) - Give Aspirin prophylaxis at 12 Weeks.
primigravida
Maternal BMI => 30kg / m2
Family history of pre-eclampsia

Question 2

What are the type of pre-eclampsia ?

Answer 2

1) Mild : [ Hypertension (BP=> 140/90 mm Hg] on 2 occasions . at least 6 hours apart without evidence of end-organ in women who is nonsensitive before 20 weeks ]
2) Severe - presence of 1 of the following criteria :

A. SBP of 160 mmhg or higher or DBP of 110 mm Hg or higher in 2 occations at least 6 houts apart.

B. Proteinuria of more than 3g in a 24-hour colelction or mroe than 3+ on 2 random urine samples collected at least 6 hours apart .

C. Pulmonary edema or cyanosis.

D. Oliguria (<400 mL in 24 hours)

E.Cerebral or visual disturbances.

F. Persistent headaches and/ or Epigastric pain.

G. Impaired liver function.

H. Increased serum creatinine (>1.2 mg/dl )

I. Retinal hemorrhages , exudates or papilledema

J. Thrombocytopenia

K. Oligohydramnios

L. Intra-uterine growth restriction (IUGR ) or placenta abruption .

Question 3

What are the one of the confirmatory Investigation for pre-eclampsia ?

Answer 3

24- hours urine protein .

Question 4

Define Pre-eclampsia ?

Answer 4

1. Hypertension of at least 140/90 mmHg .
2. Recorded on at least 2 separate occasions 3. At least 4 hours apart
3. In the presence of at least 300 mg protein in a 24-hour collection of urine
4. Arising de novo after the 20th week of pregnancy
5. In a previously normotensive woman
6. Resolving completely by the 6th postpartum week.

Question 5

What are the general RISK FACTORS for pre-eclampsia ?

Answer 5

1. First pregnancy
2. Muliparity - with a previous history of pre-eclampsia.
3. Pre-eclampsia in any previous pregnancy
4. 10 Years or more since last baby
5. Age => 40 years old .
6. Body mass index ( BMI) of 35 or more.
7. Family history of pre-eclampsia ( in mother or sister )
8. Booking diastolic blood pressure of => 80 mmHg .
9. Booking proteinuria ( of =>1+ on more than 10. one occasion or quanitfied at +> 0.3 g/24h)
10. Multiple pregnancy
11. Certain underlying medicail conditions :
    - Pre - existing hypertension.
    - Pre- existing renal disease .
    - Pre- existing diabetes.
    - Antiphospholipid antibodies .

Question 6

What is the pahophysiology of pre-eclampsia ?

Answer 6

Development of pre-eclampsia involved of 2-stages process in early pregnancy :

STAGE 1:
Trophoblasts invasion is patchy and the spiral arteries retain their muscular walls - to prevent the development of a high-flow , low impedance uteri-placental circulation ——- > lead to uteroplacenta ischaemia .

Trophoblasts invade less effectively in pre-eclampsia case due to Abnormal adaptation of maternal immune system.

STAGE 2 :
Uteroplacental ischaemia results in oxidative and inflammatory stress , with the involvement of secondary mediators leading : 1. Endothelial dysfunction. 2. Vasopasm . 3. Activation of the coagulation system. It can also lead to multisystem disorder affecting multiple organ system often continuously.

Question 7

What is the etiology of the pre-eclampsia ?

Answer 7

The proposed etiology of pre-eclampsia ?

Genetic Predisposition ———> Abnormal immunological response ——> Deficient trophoblast invasion ——> Hypoperfused placenta ———> curculating factors —–> Vascular endothelial cell activation.

STAGE 1 :
Abnormal immune response and deficient placentaiton.

STAGE 2:
Maternal endothelial cell dysfunction to maternal syndrome.