Pre-eclampsia Flashcards
What is the definition of pre-eclampsia?
It is the onset of high blood pressure and proteinuria after 20 weeks of pregnancy
What is the triad of pre-eclampsia?
- Hypertension
- Proteinuria
- Oedema
What are the two types of pre-eclampsia?
- True/primary
2. Superimposed pre-eclampsia
What are the features of true pre-eclampsia?
- No known cause
- No previous hypertension
- Usually goes back to normal 6 weeks post-partum
- Mainly primigravida
- More common in young (teenage) or above >35 years
What are the features of superimposed pre-eclampsia?
- Can be primigravida or multi-gravis a
2. Usually existing hypertension or even pyelonephritis
What are the maternal complications of pre-eclampsia?
- Renal/cardiac failure
- Stroke
- Liver failure
- Cardiac failure
- Abruptio placentae
- Eclamptic fits
What are the fetal complications of pre-eclampsia?
- Fetal distress
- Fetal death
- Intra-uterine growth restriction
- Placental insufficiency
What are the symptoms of pre-eclampsia?
- Visual disturbance
- Nausea
- Vomiting
- Epigastric pain
- Persistent headache
What is the definition of proteinuria in pregnancy?
Anything above 300 mg per 24 hours
How do we diagnose high blood pressure?
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
What is chronic hypertension?
Hypertension that has started before 20 weeks
- essential hypertension
- secondary hypertension (with underlying condition)
What is gestational hypertension?
Hypertension that starts after 20 weeks and goes back to normal after 3 months post-partum
What is pre-eclampsia?
Hypertension that occurs after 20 weeks gestational age and returns to normal after 3 months
What does pre-eclampsia present with?
- Proteinuria >300mg/day or dipstick persistently +2
- renal insufficiency, creatinine >100
- Liver disease ALT>40
- Neurological problems, convulsions, hyperreflexia with clonus, severe headache
- Haematological disturbances
- Fetal growth restriction
What is superimposed pre-eclampsia?
New development of the other features of pre-eclampsia with chronic hypertension
What is defined as proteinuria in pregnancy?
> 300 mg in 24 hours
How does oedema present in a pre-eclampitic patient?
- The patient gains weight-about 0,5kg per week
- Sacral oedema
- Trunk oedema
- Ankle oedema
- Peri-orbital oedema/puffiness
What happens to the blood vessels in pre-eclamptic patients?
The endothelial layer gets damaged which affects all systems-the brain, liver, kidneys etc
What type of patients usually present with pure/true pre-eclampsia?
- Primigravida
- Younger than 18 and older than 35
- Common in multiple pregnancy
- Common in diabetes mellitus
- Blood pressure returns to normal 6 weeks after
- Hypertension usually presents 20 weeks after gestation
What type of patients usually gets superimposed pre-eclampsia?
- Either primigravida and multigravida
- Can affect even before 20 week
- Exists with pre-existing condition such as chronic hypertension or chronic pyelonephritis
What is early onset and late onset pre-eclampsia?
Early: eclampsia that is before 34 weeks
Late: eclampsia fever 34 weeks(less complications)
If a patient presents with a systolic blood pressure what must we think of immediately?
Severe pre-eclampsia
What is HELLP syndrome?
- Haemolysis
- Elevated liver enzymes
- Low platelets
What are the features of severe pre-eclampsia?
- Systolic BP of >160mmHg and diastolic of >110mmHg
- Proteinuria that is +3, +4
- Cerebral/visual disturbance
- Pulmonary oedema
- Thrombocytopenia
- Epigastric pain
- Oliguria <400ml/24 hour
What is the medication of choice in chronic hypertension?
Methyl-dopa
Patient must stop b-blockers before pregnancy
In which conditions would a patient need to be admitted to hospital?
- Pure pre-eclampsia
2. Superimposed pre-eclampsia
What is a preventative option we can try to prevent pre-eclampsia in the next pregnancy?
Aspirin 1mg/kg/day from early second trimester
What are the special investigations we would do for these patients?
- Urine analysis-24 hr proteinuria
- FBC
- Formal HB and haematocrit
- Urea, creatinine, Uris acid
- PTT(Partial thromboplastin time), INR
- Liver function tests: LDH, LST
- Ultrasound prof the baby
WHAT DO YOU DO IF THE PRE-ECLAMPSIA is recognized <24 weeks?
Termination of pregnancy
What do we do if the patient presents between 24-36 weeks?
Bed rest as much as possible and start patient on methyldopa
What do we do if the patients presents >36 weeks with pre-eclampsia?
- Bed rest
- Start them on rapid anti-hypertensives-adalat(nifedipine), labetalol
- Monitor fetal heart
- Induce labour if favourable
- Deliver baby
What do we do if the patient starts showing signs of iimminent eclampsia?
- Severe headaches
- Nausea and vomiting
- Epigastric pain
- Hyperreflexia and clonus
What do we need to give the patient immediately to manage the pre-eclampsia?
- Magnesium sulphate and must be continued 24 hours after delivery
- Give patient rapid acting anti-hypertensive like nifedipine if diastolic pressure >100mmhg
- Evaluate the cervix-if favourable then induce labour, if not do c/s
What is eclampsia?
Convulsions associated by hypertension and proteinuria in pregnancy
-it can occur in the antepartum period, intrapartum and postpartum period
What are the risk factors for women developing eclampsia?
- Unbooked patient
- Late referral to tertiary hospital
- Delayed hospitalization
- Blindness
What happens if we decrease the blood pressure too much?
It may excarcerbate cerebral ischaemia
What is the best anti-hypertensive to safely decrease the BP without causing cerebral ischaemia?
Dihydralazine bolus over 5 minutes
What are the complications of eclampsia?
- Renal failure
- Cardiac failure
- Pulmonary oedema
- Abruptio placentae
- Cerebral haemmorhage
- Temporary blindness
What is the management of eclampsia/patient is convulsing or fitting?
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
What can we use to counteract magnesium sulphate toxicity?
Calcium gluconate
What are the maternal clinical features of magnesium sulphate toxicity?
-Respiratory depression
-hypoglycemic tetany
Maternal death
What are the ongoing/long-term treatments for patients with hypertension?
1.
What are the rapid acting drugs used to treat a acute hypertensive attack?
- Labetalol
- Dihydralazine
- Nifdedipine
