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Obstetrics > Pre-eclampsia > Flashcards

Pre-eclampsia Flashcards

1
Q

What is the definition of pre-eclampsia?

A

It is the onset of high blood pressure and proteinuria after 20 weeks of pregnancy

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2
Q

What is the triad of pre-eclampsia?

A
  1. Hypertension
  2. Proteinuria
  3. Oedema
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3
Q

What are the two types of pre-eclampsia?

A
  1. True/primary

2. Superimposed pre-eclampsia

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4
Q

What are the features of true pre-eclampsia?

A
  1. No known cause
  2. No previous hypertension
  3. Usually goes back to normal 6 weeks post-partum
  4. Mainly primigravida
  5. More common in young (teenage) or above >35 years
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5
Q

What are the features of superimposed pre-eclampsia?

A
  1. Can be primigravida or multi-gravis a

2. Usually existing hypertension or even pyelonephritis

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6
Q

What are the maternal complications of pre-eclampsia?

A
  1. Renal/cardiac failure
  2. Stroke
  3. Liver failure
  4. Cardiac failure
  5. Abruptio placentae
  6. Eclamptic fits
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7
Q

What are the fetal complications of pre-eclampsia?

A
  1. Fetal distress
  2. Fetal death
  3. Intra-uterine growth restriction
  4. Placental insufficiency
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8
Q

What are the symptoms of pre-eclampsia?

A
  1. Visual disturbance
  2. Nausea
  3. Vomiting
  4. Epigastric pain
  5. Persistent headache
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9
Q

What is the definition of proteinuria in pregnancy?

A

Anything above 300 mg per 24 hours

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10
Q

How do we diagnose high blood pressure?

A

With blood pressures of more than 140/90mmHg at least two different instances 6 hours apart
-also if there’s a 25mmHg(systolic) and 15mmHg(diastolic) difference

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11
Q

What is chronic hypertension?

A

Hypertension that has started before 20 weeks

  • essential hypertension
  • secondary hypertension (with underlying condition)
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12
Q

What is gestational hypertension?

A

Hypertension that starts after 20 weeks and goes back to normal after 3 months post-partum

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13
Q

What is pre-eclampsia?

A

Hypertension that occurs after 20 weeks gestational age and returns to normal after 3 months

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14
Q

What does pre-eclampsia present with?

A
  1. Proteinuria >300mg/day or dipstick persistently +2
  2. renal insufficiency, creatinine >100
  3. Liver disease ALT>40
  4. Neurological problems, convulsions, hyperreflexia with clonus, severe headache
  5. Haematological disturbances
  6. Fetal growth restriction
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15
Q

What is superimposed pre-eclampsia?

A

New development of the other features of pre-eclampsia with chronic hypertension

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16
Q

What is defined as proteinuria in pregnancy?

A

> 300 mg in 24 hours

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17
Q

How does oedema present in a pre-eclampitic patient?

A
  1. The patient gains weight-about 0,5kg per week
  2. Sacral oedema
  3. Trunk oedema
  4. Ankle oedema
  5. Peri-orbital oedema/puffiness
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18
Q

What happens to the blood vessels in pre-eclamptic patients?

A

The endothelial layer gets damaged which affects all systems-the brain, liver, kidneys etc

19
Q

What type of patients usually present with pure/true pre-eclampsia?

A
  1. Primigravida
  2. Younger than 18 and older than 35
  3. Common in multiple pregnancy
  4. Common in diabetes mellitus
  5. Blood pressure returns to normal 6 weeks after
  6. Hypertension usually presents 20 weeks after gestation
20
Q

What type of patients usually gets superimposed pre-eclampsia?

A
  1. Either primigravida and multigravida
  2. Can affect even before 20 week
  3. Exists with pre-existing condition such as chronic hypertension or chronic pyelonephritis
21
Q

What is early onset and late onset pre-eclampsia?

A

Early: eclampsia that is before 34 weeks
Late: eclampsia fever 34 weeks(less complications)

22
Q

If a patient presents with a systolic blood pressure what must we think of immediately?

A

Severe pre-eclampsia

23
Q

What is HELLP syndrome?

A
  1. Haemolysis
  2. Elevated liver enzymes
  3. Low platelets
24
Q

What are the features of severe pre-eclampsia?

A
  1. Systolic BP of >160mmHg and diastolic of >110mmHg
  2. Proteinuria that is +3, +4
  3. Cerebral/visual disturbance
  4. Pulmonary oedema
  5. Thrombocytopenia
  6. Epigastric pain
  7. Oliguria <400ml/24 hour
25
Q

What is the medication of choice in chronic hypertension?

A

Methyl-dopa

Patient must stop b-blockers before pregnancy

26
Q

In which conditions would a patient need to be admitted to hospital?

A
  1. Pure pre-eclampsia

2. Superimposed pre-eclampsia

27
Q

What is a preventative option we can try to prevent pre-eclampsia in the next pregnancy?

A

Aspirin 1mg/kg/day from early second trimester

28
Q

What are the special investigations we would do for these patients?

A
  1. Urine analysis-24 hr proteinuria
  2. FBC
  3. Formal HB and haematocrit
  4. Urea, creatinine, Uris acid
  5. PTT(Partial thromboplastin time), INR
  6. Liver function tests: LDH, LST
  7. Ultrasound prof the baby
29
Q

WHAT DO YOU DO IF THE PRE-ECLAMPSIA is recognized <24 weeks?

A

Termination of pregnancy

30
Q

What do we do if the patient presents between 24-36 weeks?

A

Bed rest as much as possible and start patient on methyldopa

31
Q

What do we do if the patients presents >36 weeks with pre-eclampsia?

A
  1. Bed rest
  2. Start them on rapid anti-hypertensives-adalat(nifedipine), labetalol
  3. Monitor fetal heart
  4. Induce labour if favourable
  5. Deliver baby
32
Q

What do we do if the patient starts showing signs of iimminent eclampsia?

A
  1. Severe headaches
  2. Nausea and vomiting
  3. Epigastric pain
  4. Hyperreflexia and clonus
33
Q

What do we need to give the patient immediately to manage the pre-eclampsia?

A
  1. Magnesium sulphate and must be continued 24 hours after delivery
  2. Give patient rapid acting anti-hypertensive like nifedipine if diastolic pressure >100mmhg
  3. Evaluate the cervix-if favourable then induce labour, if not do c/s
34
Q

What is eclampsia?

A

Convulsions associated by hypertension and proteinuria in pregnancy
-it can occur in the antepartum period, intrapartum and postpartum period

35
Q

What are the risk factors for women developing eclampsia?

A
  1. Unbooked patient
  2. Late referral to tertiary hospital
  3. Delayed hospitalization
  4. Blindness
36
Q

What happens if we decrease the blood pressure too much?

A

It may excarcerbate cerebral ischaemia

37
Q

What is the best anti-hypertensive to safely decrease the BP without causing cerebral ischaemia?

A

Dihydralazine bolus over 5 minutes

38
Q

What are the complications of eclampsia?

A
  1. Renal failure
  2. Cardiac failure
  3. Pulmonary oedema
  4. Abruptio placentae
  5. Cerebral haemmorhage
  6. Temporary blindness
39
Q

What is the management of eclampsia/patient is convulsing or fitting?

A 
Immediate care
1. Maintain airway
2. Left lateral position
3. Administer oxygen
4. Administer MgS04
5. Delivery within 6-8 hours
6 monitor Renal function, liver function, platelet count
7. 24-48 hours surveillance post-partum
40
Q

What can we use to counteract magnesium sulphate toxicity?

A

Calcium gluconate

41
Q

What are the maternal clinical features of magnesium sulphate toxicity?

A

-Respiratory depression
-hypoglycemic tetany
Maternal death

42
Q

What are the ongoing/long-term treatments for patients with hypertension?

43
Q

What are the rapid acting drugs used to treat a acute hypertensive attack?

A
  1. Labetalol
  2. Dihydralazine
  3. Nifdedipine

Obstetrics (18 decks)

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