Pre- Eclampsia Flashcards
What is main indication a pregnant women may have pre eclampsia?
New onset hypertension (in someone who was previously normotensive), BP ≥140 mmHg systolic and/or ≥90 mmHg diastolic
When during pregnancy can pre eclampsia occur?
After 20 weeks
What can happen to fetal movement in pre eclampsia?
It may reduce
What can happen to amniotic fluid volume movement in pre eclampsia?
It may reduce
What symptoms may occur alongside hypertension in pre eclampsia?
Headache
Abdominal pain
Visual disturbances
Describe early onset pre eclampsia?
<34 weeks
Associated with fetal and maternal symptoms
Changes in placental structure
Describe late onset pre eclampsia?
>34 weeks More common (90%) Mostly maternal symptoms Fetus generally OK Less overt/no placental changes
What type of pre eclampsia is most common?
Late onset
What maternal risk factors can cause pre-disposition to pre eclampsia?
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.
What risk is there for the mother in pre eclampsia?
Damage to many organs eg kidneys, liver, brain
Progression can cause risk of seizures
Placental abruption risk
What risk is there for the fetus in pre eclampsia?
Reduced fetal growth
Preterm birth
Pregnancy loss/stillbirth
Normally in pregnancy was do EVT cells do?
They invade maternal spiral arteries leading to endothelial and smooth muscle breakdown.
EVT become endothelial EVT and spiral arteries become high capacity
What happens in relation to EVT cells in pre eclampsia?
EVT invasion of maternal spiral arteries is limited to decidual layer.
Spiral arteries are not extensively remodeled, thus placental perfusion is restricted
What happens to the placenta in pre eclampsia?
It is not perfused well
What is the role of placental growth factor and where is it released?
Its a pro-angiogenic factor
Released in large amounts by the placenta
What is the role of Flt1?
It binds soluble angiogenic factors to limit their bioavailability
What is Flt1 a soluble form of?
VEGFR1
What happens in pre eclampsia in relation to Flt1 and PGF?
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
What can be used to predict onset of pre eclampsia?
PLGR levels alone or Flt1/PLGR ratio
How is pre eclampsia resolved?
By delivery of the placenta
What is recommended in pre eclampsia if before 34 weeks gestation?
It is preferable to try and maintain the pregnancy if possible for benefit of the fetus
What is recommended in pre eclampsia if after 37 weeks gestation?
Delivery is preferable
What is given in pre eclampsia before 34 weeks in order to prepare the fetus for deilvery? How does it help?
Corticosteroids to promote fetal lung development
What are the 3 main approaches when preventing pre eclampsia?
Weight loss (esp if BMI >35) Exercise throughout pregnancy Low-dose aspirin for high risk groups (but may only prevent early onset)
What does pre eclampsia increase risk of long term in the mother?
Cardiovascular disease
Type 2 diabetes
Renal disease
What is the risk of having pre eclampsia in the next pregnancy if someone has already had it in one pregnancy?
1/8, but this risk is greater if the pre eclampsia was early onset
