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Midwifery > Pre-eclampsia and Eclampsia > Flashcards

Pre-eclampsia and Eclampsia Flashcards

1
Q

What is pre-eclampsia?

A

A multisystem disorder of pregnancy characterised by new hypertension presenting after 20 weeks with significant proteinuria.

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2
Q

What is the classification of hypertension?

A

BP of 140/90- 159/109.

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3
Q

What is the classification of severe hypertension?

A

BP of > 160/110.

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4
Q

Up to 3% of pregnancies in the UK are affected by pre-eclampsia. What are the maternal complications?

A
  • Intracranial haemorrhage
  • Placental abruption
  • Eclampsia
  • HELLP syndrome
  • Disseminated intravascular coagulation
  • Renal failure
  • Pulmonary oedema
  • Acute respiratory distress syndrome
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5
Q

What are the fetal complications of pre-eclampsia?

A
  • FGR (USS every 2 weeks or dopplers to assess growth/blood flow)
  • Oligohydramnios
  • Hypoxia due to placental insufficiency
  • Placental abruption
  • Preterm birth
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6
Q

Though not fully understood, what is the suspected cause of pre-eclampsia?

A

-Inadequate invasion of the maternal spiral arterioles into the trophoblastic cells (layer of tissue that eventually forms a large part of the placenta) resulting in decreased uteroplacental perfusion.

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7
Q

Why is pre-eclampsia considered a placental disorder?

A

Because the syndrome usually resolves once the placenta is delivered.

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8
Q

What are the predisposing maternal risk factors?

A
  • Nulliparity
  • Previous pre-eclampsia
  • Hypertensive disorder during previous pregnancy
  • Chronic hypertension
  • Family history of pre-eclampsia (25% if mother has had it, 40% if sister)
  • Multiple pregnancy
  • Obesity
  • Renal disease
  • Maternal age >40
  • Autoimmune diseases (e.g. antiphospholipid syndrome)
  • If 10 years or more since last pregnancy
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9
Q

What are the fetal risk factors?

A
  • Chromosome anomalies
  • If it’s a multiple pregnancy
  • Structural congenital anomalies
  • A hydatidiform mole (molar pregnancy)
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10
Q

If symptomatic, what are the symptoms displayed by someone suffering with pre-eclampsia?

A
  • Epigastric pain
  • Headaches (particularly frontal headaches)
  • Visual disturbances (blurred vision or flashing lights)
  • Sudden swelling of the feet, ankles, face and hands
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11
Q

Antenatal detection- What can you do to screen for pre-eclampsia?

A
  • BP at every appointment using the correct sized cuff
  • Urinalysis
  • Abdominal palpation-any pain?
  • Discuss symptoms to be aware of (epigastric pain, headaches, visual disturbances)
  • Refer for further hospital assessment if concerned
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12
Q

How can you screen for pre-eclampsia antenatally?

A
  • BP measurements at every appointment (ensure correct cuff size)
  • Urinalysis
  • Abdominal palpation (any pain?)
  • Ask about symptoms- ensure women are aware of signs and symptoms and contact numbers if they experience any.
  • Refer to ANC for assessment if concerned. Will be admitted if diastolic BP >90.
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13
Q

How is pre-eclampsia detected/confirmed in the antenatal clinic?

A
  • Via blood tests- Lab investigations

- Antenatal examination (fetal assessment required too!)

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14
Q

What haematological changes can occur in a woman with pre-eclampsia?

A
  • A rise in Hb as a result of reduced plasma volume (reduced plasma vol only occurs in women with pre-eclampsia)
  • A rise in haematocrit (ratio of RBC’s to vol of blood- again, because of reduced plasma)
  • A drop in platelets (Alert anaesthetist if >100)
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15
Q

What changes can occur to the renal function?

A
  • Rise in urates
  • Rise in creatinine (as GFR reduces)
  • Rise in urea
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16
Q

What changes occur to the liver function?

A

-A rise in ALT
-A rise in AST
-A decrease in albumin due to protein loss in urine
-A decrease in total protein due to loss in urine
[Bilirubin should be normal. Raised bilirubin levels could indicate HELLP)

17
Q

Regarding delivery, how are women with pre-eclampsia cared for?

A
  • With antihypertensives (labetalol, nifedipine etc…)
  • IOL or LSCS. Timing of birth dependant on severity of symptoms (may need planned early birth).
  • Epidural recommended for analgesia
  • Constant 1:1 care
  • 24h observation charts (including IVI, reflexes and in severe cases central venous pressure (CVP) line.
  • Strict fluid balance, hourly urine measurement and monitoring of proteinuria
  • Medical review if spO2 falls below 95%
  • Ventouse/forceps considered to reduce intracranial pressure of pushing
  • Syntocinon advised for 3rd stage (ergometrine contraindicated)
  • Thromboprophylaxis (TEDS, compression boots, LMWH considered post birth)
  • Monitor clotting factors, FBC, LFT’s and U+E’s
18
Q

What solution is used as a treatment for severe pre-eclampsia/eclampsia?

A

Magnesium Sulfate.

Route- IV

19
Q

Why is magnesium sulfate used?

A

In people with pre-eclampsia, the blood vessels in the brain are constricted, leading to cerebral ischemia and seizures. Magnesium sulfate works by dilating these blood vessels, which can improve the blood supply to the brain.

20
Q

What are the side effects of magnesium sulfate? and what is the antidote?

A
  • Motor paralysis
  • Absent tendon reflexes
  • Cardiac disturbances (arrhythmia or bradycardia)
  • Respiratory despression
  • Nausea/Vomitting

Manage with 10% calcium gluconate given IV over 3 minutes

21
Q

What is Eclampsia?

A

A very serious complication of pre-eclampsia, characterized by one or more seizures during pregnancy or in the post-partum period.

22
Q

When can eclampsia occur?

A

Anytime!

  • Antenatal occurrence = 45%
  • Intrapartum = 15%
  • Postpartum= 40%
23
Q

What are the symptoms of Eclampsia before the onset of seizures?

A
  • Sharp rise in BP
  • Diminished urine output – increased proteinuria
  • Severe headache – frontal and persistent
  • Drowsiness and confusion
  • Visual disturbances
  • Nausea and vomiting
24
Q

What is the loading dose of magnesium sulfate and over what period of time should it be given?

A
  • 4g (8ml of 50% solution mixed with 12ml of 0/9% saline)

- Given as IV bolus over 5-15 minutes

25
Q

What is the maintenance dose of magnesium sulfate?

A

1g/hour for 24hrs following birth or since the last seizure (whichever event is the most recent)

26
Q

What is the management of women with Eclampsia?

A
  • Stabilise the mother before delivering fetus – LSCS
  • Regional unit – HDU/ICU
  • Intensive care charts – frequent observations
  • IV anti-hypertensives and anti-convulsant treament
  • Strict fluid balance - CVP line?
  • Watch for DIC, HELLP syndrome
27
Q

What are the (multisystem) complications of eclampsia?

A
  • Cardiovascular – pulmonary oedema
  • Renal – ischaemia, oligura, renal failure
  • Haematological – DIC haemorrhage
  • Neurological – cerebral oedema and haemorrhage
  • Hepatic – damage subcapsular haematoma hepatic rupture
  • Fetal – placental abruption, IUGR, fetal distress and death

[Hepatic system: includes veins that carry blood from digestive organs to the liver (part of body’s filtration system)]

28
Q

There are 4 stages of deterioration in eclampsia?

A
  • Premonitory stage
  • Tonic stage
  • Clonic stage
  • Coma
29
Q

What happens in the premonitory stage?

A
  • Lasts 10-20 seconds
  • Woman feels restless
  • May have rapid eye movement

Can easily be missed

30
Q

What happens in the tonic stage?

A
  • Lasts 10-20 seconds
  • Muscle spasms
  • Arching of the back
  • Clenching teeth
  • Cyanosis
31
Q

What happens in the clonic and coma stages?

A

-1-2 minutes of convulsions. The woman is unconscious.

Coma. After this the woman may enter into a coma for a variable amount of time.

32
Q

For women at high risk of developing pre-eclampsia, what are they given antenatally to reduce this risk?

A

Asprin 75-100mg OD

Midwifery (7 decks)

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