Pre-eclampsia

Question 1

What is pre-eclampsia characterised by:

Answer 1

• multisystem involvement
• hypertensino of at least 140/90 on 2 seperate occasions 4 hours apart
• occurs at 20 weeks + gestation
• resolves within 6 weeks postnatal
• sigmificant cause of maternal and foetal morbidity

Question 2

complications of pre-eclampsia

Answer 2

eclampsia

HELLP syndrome

Question 3

risk factors for Pre-eclampsia

Answer 3

first pregnancy

Multiple pregnancies (twins?)

Donor eggs/ embryo

Previous bistro of pre-eclampsia

BMI >35

>40 years of age

Pregnancy interval >10 years

Underlying medical conditions: e.g., DM, renal disease, hypertension

Question 4

what is pre-eclampsia

Answer 4

a hypertensive disorder of pregnancy caused by abnormal placentation leading to a maternal inflammatory response

Question 5

are women asympotmatic

Question 6

if women are asympotmatic, how are most diagnosed?

Answer 6

routine antenatal screening

Question 7

classification of pre

Answer 7

Chronic hypertension

PIH (pregnancy induced hyopertension)

PIH + proteinuria

Proteinuria w/ hypertension

Question 8

Pathophysiology

Answer 8

1. Impaired trophoblast invasion (causes vasospasm) + spiral artery remodelling
2. Decreased utero-placental perfusion
3. Placental hypoxia
4. Decreased NO and prostaglandin oroduction (lack of vasodilators)
5. Decreased angiogenesis and endothelial dysfunction

Question 9

multi system effects

Answer 9

eclampsia

hypertension

cardiomyopathy

increased RAAS sensitivity

thrombocytopaenia

pulmonary oedema

neurological effects- fitz

Question 10

signs

Answer 10

clonus

hyperreflexia

platelets <100

creatinine > 200

ALT > 50

haemolysis (drop in Hb)

Question 11

symptoms

Answer 11

headache

nausea and vomiting

oedema

epigastric pain

oligiuria

Question 12

investigations for diagnosis

Answer 12

1. BP > 140/90—— BP usually falls in pregnancy
2. urine analysis- dip for proteinuria
3. Bloods- FBC, dotting profile, LFTs and U+E

Question 13

prevention

Answer 13

primary prevention can’t be done as the cause is unknown

secondary prevention: heparin reduces recurrance for women w thrombophilia

tertiary prevention: good antenatal care and surveilance

Question 14

prediction methods for pre-eclampsia

Answer 14

angiogenic factor (sFIlt)- prediction from urinary test

PIGF- placental growth factor synthesised by syncitiotrophoblasts. reduced levels are predictive of PET (pre-eclampsia toxaemia)

Question 15

Drugs used in treatment

Answer 15

1. Anti-hypertensives- to control high blood pressure —-hydralazine?
2. To reduce risk of seizures—- magnesium sulphate
3. Steroids (dexamthesone) to help the foetus lung formation

Question 16

Management

Answer 16

MDT involvement

Fluid restriction

Observation (BP/ pulse/ RR/ urine output/ reflexes)

Bloods, biochemistry and urinary protein monitoring

Drugs (antihypertensives, magnesium sulphate, steroids)

Foetal monitoring (mother takes priority over foetus)

Question 17

Delivery and follow up

Answer 17

Vaginal or caesarean section (depending on gestation and severity)

Epidural vs. general anaesthesia

Post-partum haemorrhage treatment

Continue mag sulph for 24 hours

Monitor bloods and biochem

Monitor BP

Consider venousthromboembolism prophylaxis when safe to do so

Arrange follow up

Question 18

Variants of pre-eclampsia toxaemia

Answer 18

Eclampsia

• Seisures
• Mortality
• Obstetric emergency
• Mag sulph IV
• Stabilise mother and deliver

HELLP

Haemolysis

elevated liver enzymes

low platelets

results from endothelial damage

risk of disseminated intravascaulr coagulation