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OBSTETRICS - YR 3 > Pre eclampsia and Eclampsia > Flashcards

Pre eclampsia and Eclampsia Flashcards

1
Q

Definition of pre eclampsia

A
  1. BP > 140/90
  2. > 300 mg of proteinuria
  3. within 24 hours
  4. After 24 weeks
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2
Q

PAPP-A in pre eclampsia

A
  1. Low pregnancy associated plasma protein associated with high risk of pre eclampsia
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3
Q

Blood test results in pre eclampsia

A
  1. Raised uric acid
  2. Low platelets
  3. High Hb
    ( help differentiate pre eclampsia from PIH)
  4. Low PAPP-A
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4
Q

Ultrasound results indicating pre eclampsia

A
  1. Uterine artery doppler at 11-13 or 22-24 predictive of early onset pre eclampsia
  2. Fetal growth restrictions on ultra sound
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5
Q

Risk factors for pre eclampsia

A
  1. Previous onset pre eclampsia x 7 risk
  2. Age > 40
  3. Family history
  4. Obesity
  5. Multiple pregnancy
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6
Q

Pre existing medical conditions which increase risk of pre eclampsia ;

A
  1. Hypertension
  2. Renal disease
  3. Diabetes
  4. Anti phospholipid antibodies
  5. Thrombophilia
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7
Q

Prevention of pre eclampsia

A

Women with past medical history of severe early onset pre eclampsia should be offered low dose asprin < 16 weeks to reduce incidence

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8
Q

Most common presentation of pre eclampsia

A

Asymptomatic

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9
Q

Symptoms which may occur in severe pre eclampsia

A
  1. Head ache - frontal
  2. Visual disturbance
  3. Epigastric/RUQ pain
  4. N & V
  5. Facial oedema
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10
Q

Pain in pre eclampsia

A
  1. Frontal headache

2. Epigastric/RUQ pain

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11
Q

Cerebral signs of pre eclampsia

A
  1. Hyper reflexia and or clonus > 3 beats is a sign of cerebral irritability
  2. Confusion
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12
Q

Pre eclampsia increases the risk of

A

Placental abruption

- uterine tenderness or vaginal bleeding may be seen from a placental abruption

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13
Q

FBC results

A
  1. High Hb
  2. Thrombocytopenia
  3. Anaemia if hemolysis ( HELLP syndrome)
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14
Q

Coagulation screening

A

Prolonged

  • prothrombin time
  • Activated partial thromboplastin time
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15
Q

Biochemistry

A
  1. Increased Urate
  2. Increased Urea
  3. Abnormal LFTs
  4. Lactate dehydrogenase is raised ( marker for haemolysis )
  5. Increased proteinuria
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16
Q

Severe complications of Pre eclampsia

A
  1. HELLP
  2. Cerebral haemorrhage
  3. IUGR and fetal compromise
  4. Placental abruption
17
Q

When is outpatient management appropriate?

A
  1. BP < 160/<110
  2. No or low proteinuria
  3. Difficult to distinguish from gestational hpt
18
Q

Out patient management of pre eclampsia

A
  1. Warn about symptom development
  2. 1 - 2 week review about BP and urine
  3. Weekly review of bloods
19
Q

Mild - moderate pre eclampsia defined as t

A 
BP < 160/<110
Significant proteinuria (>300mg)
20
Q

Management of mild - moderate pre eclampsia

A
  1. Admission
  2. 4 hourly BP
  3. 24 hour urine collection for protein
  4. Daily urinalysis
  5. Fetal CTG daily
  6. Regular US
  7. Regular blood tests
21
Q

Define severe pre eclampsia

A

BP > 160 / >110 in the presence of significant proteinuria

22
Q

Treatment of severe pre eclampsia

A
  1. Only treatment is full delivery of the placenta
23
Q

Management of severe pre eclampsia

A
  1. BP stabilised with antihypertensives ( < 169/ <110)
  2. Per oral Nifedipine or IV labetalol for immediate management
  3. Maintainance therapy with Methydopa
24
Q

Eclampsia

A

Tonic clonic seizures in association with a diagnosis of Pre eclampsia

25
Q

When can Eclampsia occur?

A
  1. Antenatally ( 38%)
  2. Intrapartum (20%)
  3. Postnatally within 48 hours (44%)
  4. May be initial presentation of pre eclampsia, may occur before hpt or proteinuria
26
Q

HELLP syndrome definition

A
  • Serious complication of pre eclampsia
  • Manifests as;
    1. Haemolysis
    2. Elevated liver enzymes
    3. Low platelets
27
Q

HELLP syndrome

A

Liver enzymes increase and platelets decrease before hemolysis occurs

28
Q

Symptoms of HELLP syndrome

A
  1. Epigastric or RUQ pain
  2. Nausea and vomiting
  3. Tea coloured urine due to hemolysis
29
Q

Urine in HELLP syndrome

A

tea coloured due to hemolysis

30
Q

Signs in HELLP syndrome

A
  1. tenderness in RUQ
  2. Increase in BP and other features of pre eclampsia
  3. Eclampsia may co exist
31
Q

Management of HELLP syndrome

A
  1. Delivery is indicated
  2. Magnesium sulphate indicated
  3. Platelet infusion only if there is bleeding or surgery ( not for low levels caused by the syndrome)

OBSTETRICS - YR 3 (20 decks)

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