Pre-eclampsia

Question 1

what investigations are useful in assessing foetal wellbeing if the mother has been diagnosed pre-eclampsia?

what results from these tests would be concerning?

Answer 1

Umbilical artery doppler velocity
- absence of end diastolic blood flow

Amniotic fluid assessment
- deepest vertical pocket < 2cm

Foetal ultrasound scan

• reduced foetal movements
• intrauterine growth restriction

Placental growth factor

Cardiotocography

Question 2

what is the treatment for Eclampsia?

Answer 2

4-6g IV magnesium sulphate loading dose over 20-30 minutes

Followed by 1-2g/hour infusion over 24 hours

Question 3

what is the first line medical treatment for pre-eclampsia?

Answer 3

Labetalol 20mg IV initially

if BP not stabilised within 30 minutes give 40mg oral
if BP not stabilised within 30 mins give 80mg oral
if BP not stabilised within 30 mins switch to hydralazine and seek specialist advice

Question 4

what are the treatment options for pre-eclampsia?

Answer 4

Mild: Close monitoring with no medications
- steroids if < 36 weeks gestation (dexamethasone or betamethasone)

Moderate: medical therapy
1st line: Labetalol 20mg IV initially
other: Hydralazine 5-10mg IV initially
other: Nifedipine 10mg oral initially

Severe: delivery

• c-section if < 32 weeks
• option if > 32 weeks

Question 5

what prophylaxis should mothers who have previously had pre-eclampsia be given when they fall pregnant again?

Answer 5

low dose aspirin (81mcg) from 12 weeks

Question 6

what are contraindications for use of Hydralazine?

Answer 6

SLE

acute porphyria

Question 7

what is a contraindication for use of Labetalol?

Answer 7

asthma

Question 8

what is a potential side effect to the neonate of use of Hydralazine?

Answer 8

neonatal thrombocytopenia

Question 9

what is a potential side effect of labetalol to the foetus?

Answer 9

infant alpha and/or beta blockage

Question 10

at what gestation is delivery for pre-eclampsia the most preferred option of treatment?

Answer 10

> 37 weeks