Pre-Eclampsia and Eclampsia

Question 1

Pre-Eclampsia and Eclampsia Defnitions

Answer 1

Pre-Eclampsia

• Pregnancy induced hypertension associated with proteinuria with or without oedema
• Relatively common condition characterised by maternal hypertension, proteinuria, oedema, IUGR and premature birth
• Severe pre-eclampsia is BP of 160S or 119D and or symptoms and or biochemical/haematological impairment
• Eclampsia is one or more convulsions superimposed on pre-eclampsia

Question 2

Pre-Eclampsia and Eclampsia Epidemiology

Answer 2

• Severe is rare, second leading cause of maternal death

- 44% of seizures post natal, the rest ante or intrapartum

Question 3

Pre-Eclampsia and Eclampsia RFs

Answer 3

Moderate RFs
-10 years since last pregnancy, first pregnancy, age >40, high BMI, FHx, multiple pregnancy
High Res
-PHx, pre-existing; hypertension, CKD, DM, SLE

Question 4

Pre-Eclampsia and Eclampsia Aetiology

Answer 4

• Poorly understood
• Suboptimal uteroplacental perfusion with maternal inflammatory response, (spiral arteries etc.)
• Leads to endothelial dysfunction, vascular hyperpermeability, thrombophilia, hypertension
• Can lead to end organ damage

Question 5

Pre-Eclampsia and Eclampsia Presentation

Answer 5

• Systolic BP >140 or DBP>90 in second half of pregnancy with ≥1+ proteinuria on reagent stick testing
• New hypertension
• New significant proteinuria
• Severe headache, sudden swelling of face, hands and feet, liver tenderness, visual disturbance, epigastric, vomiting, platelet count falling, abnormal LFTs, clonus, HELLP syndrome, papilloedema. foetal distress, SGA

Question 6

Pre-Eclampsia and Eclampsia Referral

Answer 6

Refer if

• Raised BP with proteinuria ≥1+
• SBP≥160
• DBP≥100
• Any signs of pre-eclampsia

Question 7

Pre-Eclampsia and Eclampsia Ix

Answer 7

• Urinalysis
• Doppler velocimetry
• Frequent monitoring of FBCs, U/Es, LFTs (HELLP)
• Clotting studies if severe pre-eclampsia (liver dysfunction)
• Urinalysis
• Proteinuria is not mandatory to diagnose; can be based off foetal growth restriction or systemic symptoms)
• Assessment of foetus

Question 8

Pre-Eclampsia and Eclampsia Management

Answer 8

• Multi-disciplinary; obstetrics, anaesthetics, haematology, paediatrics
• Delivery of placenta is only cure
• Monitor for signs of progression to eclampsia
• See management of hypertension in pregnancy
• Treat with labetalol (methyldopa 2nd line) if 150-159/100-109
• USS
• Cardiotocography (repeat if change in foetal movements, PV bleeding, abdominal pain, deterioration)
• fullPIERS or PREP-S
• If severe, labetalol IV, magnesium sulfate 4g IV over 5-15 mins, monitor fluid balance

Question 9

Eclampsia Management

Answer 9

• A-E with oxygen
• Treat seizures with magnesium sulfate 4g IV
• Treat hypertension with IV labetalol
• Fluid therapy
• Delivery
• Postpartum; monitor BP until 130/80 then stop treatment, urine dip
• Enalapril during postnatal period

Question 10

Pre-Eclampsia and Eclampsia Prevention

Answer 10

• Aspirin for those at risk after 12 weeks

- Maybe calcium supplements, evidence is weak