Pre-eclampsia and eclampsia

Question 1

What is pre-eclampsia?

Answer 1

New hypertension in pregnancy with end organ dysfunction or proteinuria

Question 2

What is eclampsia?

Answer 2

When seizures develop as a cause of pre-eclampsia

Question 3

What is gestational hypertension?

Answer 3

New hypertension in pregnancy after 20 weeks that is not associated with proteinuria

Question 4

What is the triad seen in pre-eclampsia?

Answer 4

Hypertension
Proteinuria
Oedema

Question 5

What is the cause of pre-eclampsia?

Answer 5

Pre-eclampsia is caused by poor vascular resistance in the spinal arteries and poor perfusion of the placenta

Question 6

What are high risk factors for pre-eclampsia?

Answer 6

Pre-existing hypertension
Pre-eclampsia in a previous pregnancy
Existing autoimmune conditions
Diabetes
CKD

Question 7

What are moderate risk factors for pre-eclampsia?

Answer 7

High BMI
Age > 40
More than 10 years since previous pregnancy
First pregnancy
Multiple pregnancy
Family history of pre-eclampsia

Question 8

What may be offered as prophylaxis for pre-eclampsia?

Answer 8

Aspirin (from week 12)

Question 9

Who should be offered prophylaxis for pre-eclampsia?

Answer 9

Women with one high risk factor, or multiple moderate risk factors

Question 10

What are the symptoms of pre-eclampsia?

Answer 10

Visual disturbances
Headache
Nausea and vomiting
Epigastric pain
Oedema
Reduced urine output
Brisk reflexes

Question 11

What is the diagnosis criteria for pre-eclampsia?

Answer 11

Hypertension (over 140 systolic or 90 diastolic)
PLUS any of:
- Proteinuria
- Evidence of end organ damage
- Placental dysfunction

Question 12

What are the indicators of organ dysfunction in pre-eclampsia?

Answer 12

Raised liver enzymes
Thrombocytopenia
Raised creatinine
Seizures
Haemolytic anaemia

Question 13

What test can be used to rule out pre-eclampsia?

Answer 13

Placental growth factor
- Tested for in women suspected of pre-eclampsia between 20 and 35 weeks
- Levels will be low in pre-eclampsia

Question 14

What tests are used to monitor pre-eclampsia?

Answer 14

Blood pressure
Symptom monitoring
Urine dipstick
Ultrasound monitoring of fetus

Question 15

What is the management of gestational hypertension?

Answer 15

Aim for BP 135/85
Admission for BP 160/110
Urine dipstick testing weekly
Bloods weekly
PlGF testing on one occasion
Serial fetal growth scans

Question 16

What is the first line pharmacological management of pre-eclampsia?

Answer 16

Labetolol

Question 17

What other anti-hypertensives can be used in the management of pre-eclampsia?

Answer 17

Nifedipine - second line
Methyldopa - third line

Question 18

What is the first line management of pre-eclampsia after delivery?

Answer 18

Enalapril

Question 19

What are the second and third line management options for pre-eclampsia after delivery?

Answer 19

Nifedipine or amlodipine
Labetolol or atenolol

Question 20

What antihypertensive is given in severe pre-eclampsia or eclampsia?

Answer 20

IV hydralazine

Question 21

What medication is given during delivery and in the 24 hours after to prevent seizures?

Answer 21

IV magnesium sulfate

Question 22

What medication is used to manage seizures associated with eclampsia?

Answer 22

IV magnesium sulfate

Question 23

What are the maternal complications of pre-eclampsia?

Answer 23

Eclampsia
HELLP syndrome
Disseminated intravascular coagulation
Organ failure

Question 24

What are the foetal complications of pre-eclampsia?

Answer 24

Intrauterine growth restriction
Pre-term delivery
Placental abruption
Neonatal hypoxia

Question 25

What is HELLP syndrome?

Answer 25

Haemolysis
Elevated liver enzymes
Low platelets

Question 26

What is the definitive curative treatment of pre-eclampsia?

Answer 26

Delivery of the placenta

Question 27

What must be monitored whilst magnesium sulfate is given?

Answer 27

Respiratory rate due to the risk of respiratory depression as a side effect

Question 28

How often should women with pre-eclampsia be monitored?

Answer 28

They should have U&Es, FBC, transaminases and LFTs three times per week