Pre- Eclampsia

Question 1

What is main indication a pregnant women may have pre eclampsia?

Answer 1

New onset hypertension (in someone who was previously normotensive), BP ≥140 mmHg systolic and/or ≥90 mmHg diastolic

Question 2

When during pregnancy can pre eclampsia occur?

Answer 2

After 20 weeks

Question 3

What can happen to fetal movement in pre eclampsia?

Answer 3

It may reduce

Question 4

What can happen to amniotic fluid volume movement in pre eclampsia?

Answer 4

It may reduce

Question 5

What symptoms may occur alongside hypertension in pre eclampsia?

Answer 5

Headache
Abdominal pain
Visual disturbances

Question 6

Describe early onset pre eclampsia?

Answer 6

<34 weeks
Associated with fetal and maternal symptoms
Changes in placental structure

Question 7

Describe late onset pre eclampsia?

Answer 7

>34 weeks 
More common (90%)
Mostly maternal symptoms
Fetus generally OK
Less overt/no placental changes

Question 8

What type of pre eclampsia is most common?

Answer 8

Late onset

Question 9

What maternal risk factors can cause pre-disposition to pre eclampsia?

Answer 9

Previous pregnancy with pre-eclampsia
BMI >30 (esp >35)
Family history
Increased maternal age (>40, <20?)
Gestational hypertension or previous hypertension
Pre-existing conditions: diabetes, PCOS, renal disease, subfertility, autoimmune disease.

Question 10

What risk is there for the mother in pre eclampsia?

Answer 10

Damage to many organs eg kidneys, liver, brain
Progression can cause risk of seizures
Placental abruption risk

Question 11

What risk is there for the fetus in pre eclampsia?

Answer 11

Reduced fetal growth
Preterm birth
Pregnancy loss/stillbirth

Question 12

Normally in pregnancy was do EVT cells do?

Answer 12

They invade maternal spiral arteries leading to endothelial and smooth muscle breakdown.
EVT become endothelial EVT and spiral arteries become high capacity

Question 13

What happens in relation to EVT cells in pre eclampsia?

Answer 13

EVT invasion of maternal spiral arteries is limited to decidual layer.
Spiral arteries are not extensively remodeled, thus placental perfusion is restricted

Question 14

What happens to the placenta in pre eclampsia?

Answer 14

It is not perfused well

Question 15

What is the role of placental growth factor and where is it released?

Answer 15

Its a pro-angiogenic factor

Released in large amounts by the placenta

Question 16

What is the role of Flt1?

Answer 16

It binds soluble angiogenic factors to limit their bioavailability

Question 17

What is Flt1 a soluble form of?

Answer 17

VEGFR1

Question 18

What happens in pre eclampsia in relation to Flt1 and PGF?

Answer 18

There is excess production of Flt-1 by distressed placenta

This causes reduction of available pro-angiogenic factors in maternal circulation, resulting in endothelial dysfunction

Question 19

What can be used to predict onset of pre eclampsia?

Answer 19

PLGR levels alone or Flt1/PLGR ratio

Question 20

How is pre eclampsia resolved?

Answer 20

By delivery of the placenta

Question 21

What is recommended in pre eclampsia if before 34 weeks gestation?

Answer 21

It is preferable to try and maintain the pregnancy if possible for benefit of the fetus

Question 22

What is recommended in pre eclampsia if after 37 weeks gestation?

Answer 22

Delivery is preferable

Question 23

What is given in pre eclampsia before 34 weeks in order to prepare the fetus for deilvery? How does it help?

Answer 23

Corticosteroids to promote fetal lung development

Question 24

What are the 3 main approaches when preventing pre eclampsia?

Answer 24

Weight loss (esp if BMI >35)
Exercise throughout pregnancy 
Low-dose aspirin for high risk groups (but may only prevent early onset)

Question 25

What does pre eclampsia increase risk of long term in the mother?

Answer 25

Cardiovascular disease
Type 2 diabetes
Renal disease

Question 26

What is the risk of having pre eclampsia in the next pregnancy if someone has already had it in one pregnancy?

Answer 26

1/8, but this risk is greater if the pre eclampsia was early onset