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OBGYN 2023 > pre-eclampsia and eclampsia - GM > Flashcards

pre-eclampsia and eclampsia - GM Flashcards

1
Q

define pre-eclampsia

A

multisystem syndrome developing after 20 weeks
de novo hypertension which co-exsits with one or more of the following:
- renal involvement
- haematological involvment
- liver innvolvement
- neurological involvemnt
- pulmonary oedema
- FGR

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2
Q

renal involvement in pre eclmapsia

A

significant proteinuria
serum or plasma creatinine >90
oliguria <80ml/4 hours

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3
Q

haematological involvement in pre eclampsia

A

thrombocytopaenia
haemolysis pattern on blood film
DIC

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4
Q

neurological involvement

A

convulsions
persistent visual disturbances
persistent new headache
stroke

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5
Q

liver innvolvement in pre eclampsia

A

raised transmaminases
severe epigastric or right upper quadrant pain

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6
Q

how common is pre-eclampsia

A

2-8% pregnancies
0.5% develop severe life threatening pre eclampsia
1 in 4000 pregnancies develop to eclampsia (maternal seizures)

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7
Q

aetiology of pre eclampsia

A

due to poor perfusion of the placenta resulting in release of pro inflammatory cytokines, causing peripheral endothelial dysfunction

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8
Q

is oedema a sign of pre eclampsia

A

no longer included in the definition because it occurs equally in women with and without pre eclampsia
rapid development of oedema should still alert the clinician to screen for pre eclampsia

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9
Q

high risk factors for pre-eclampsia

A

chronic hypertension
hypertensive disease in a previous pregnancy
type 1 or type 2 diabetes mellitus
chronic kidney disease
autoimmune disease
- anti-phospholipid syndrome
- systemic lupus erythematosus

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10
Q

moderate risk factors for pre-eclampsia

A

aged 40 and over
first pregnancy
pregnancy interval >10 years
multiple pregnancy
pre-pregnancy obesity (BMI >35kg/m2)
family history of pre eclampsia

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11
Q

symptoms of pre eclampsia may include

A

pateints often have no symtpoms
- headache
- visual disturbance such as blurring or flashing lights
- swelling or arms, legs and face
- nausea and vomiting
- abdominal pain
- reduced urine output

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12
Q

clinical signs of pre-eclampsia

A

hypertension
oedema: typically in the peripheries and face
epigastric/right upper quadrant tenderness
hyper reflexia and clonus (indicates an increased risk of eclamptic seizure)
papilloedema

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13
Q

ddx of pre eclampsia

A

chronic hypertension: occurs before 20 weeks gestations. or persists after 12 weeks post partum
gestational hypertension: occurs after 20 weeks gestation that develops without any co-existing complications
pre-eclampsia superimposed on chronic hypertension: hypertension that already exists but worsens after 20 weeks gestation alongside the development of coexisting complications

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14
Q

chronic hypertension is

A

hypertension occuring before 20 weeks and persisting after 12 weeks post partum

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15
Q

gestational hypertension is

A

hypertension occuring after 20 weeks gestation that develops without any complications
resolves within 3 months post partum

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16
Q

how does antenatal screening detect pre-eclampsia

A

antenatal appointments include assessment of blood pressure, a urine dipstick test to identify proteinuria and fetal heart auscultation

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17
Q

lab investigations for pre-eclampsia

A

FBCs: low platelet count may suggest HELLP syndrome
U&Es: raised urea, raised creatinine and low eGFR indicate renal impairment
LFTs: raised ALT or AST indicate liver dysfunction
clotting profile: clotting may be deranged in the context of disseminated intravascular coagulation (DIC)

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18
Q

placental growth factor (PIGF)

A

supports trophoblastic growth and placental angiogenesis
a blood test measuring PIGF levels can be used to aid diagnosis in pre-eclampsia
elevated levels of PIGF indictae that pre-eclampsia is unlikely

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19
Q

diagnostic criteria for pre-eclampsia

A

hypertension > 140mmHg systolic or >90 mmHg diastolic
proteinuria >300mg protein in a 24 hour urine collection
maternal organ dysfunction: liver involvement, renal insufficiency, haematological complications and neurological involvement eg. visual disturbance
uteroplacental dysfunction: IUGR/stillbirth

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20
Q

monitoring of patient with pre eclampsia involves

A

regular blood pressure assessment
regular screening for proteinuria
regular blood tests including FBC, U&Es and LFTs

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21
Q

regular fetal monitoring for patient with pre eclampsia

A

CTG: assessment of fetal heart beat
US: assessment of fetal growth and amniotic fluids
umbilical artery doppler velocimetry: assessment of placental and fetaal circulation

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22
Q

medical management of pre-eclampsia

A

aspirin
antihypertensives: PO nifedipine is first line, IV labetolol is second line and methyldopa is first line
venous thromboembolism prophylaxis: due to increased VTE risk

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23
Q

when to prescribe aspirin for pre-eclampsia

A

should be prescribed from 12 weeks gestation until delivery for patients with one high risk factor or two moderate risk factors

24
Q

which VTE prophylaxis should be used

A

low molecular weight heparin
physical measures eg. anti-embolism stockings

25
Q

severe pre-eclampsia

A

BP > 160mmHg systolic or >110mmHg diastolic
requires hospital admission

26
Q

maternal complications of pre-eclampsia

A

multi-organ dysfunction: with progressive worsening to multi-organ failure
cardiovascular complications: MI or stroke
placental abruption
eclampsia
HELLP syndrome

27
Q

eclampsia

A

seizures occuring in pregnancy or within 10 days of delivery as well as two of the following within 24 hours of the seizure
- hypertension
- proteinuria
- thrombocytopaenia
- raised AST

28
Q

mortality of eclampsia

A

high mortality rate: 1 in 50 women, 1 in 14 unborn babies

29
Q

treatment of eclampsia

A

obstetric emergency requiring hospital admission
IV magnesium sulphate and early delivery
corticosteroids to accelerate fetal lung maturation if less than 34 weeks

30
Q

HELLP syndrome

A

endothelial damage and consequent thrombi formation associated with pre-eclampsia
develops in 10-20% of women with pre-eclampsia

31
Q

what does HELLP stand for

A

Haemolysis: red blood cells become damaged by the abnormal endothelium, resulting in. microangiopathic. haemolytic anaemia
Elevated Liver enzymes: raised ALT and/or AST can occur due to hepatic sinusoid obstruction by fibrin
Low Platelets: platelet levels drop below 150 x 10^9 due to platelet consumption as a result of thrombi formation

32
Q

why does HELLP syndrome cause thrmbocytopaenia

A

due to platelet consumption during multiple thrombi formation

33
Q

what might a blood film from a patient with HELLP syndrome look like

A

it would contain schistocytes (fragmented red blood cells)

34
Q

what causes Haemolysis in HELLP syndrome

A

red blood cells become damaged by the abnormal endothelium, resulting in microangiopathic haemolytic anaemia

35
Q

management of HELLP

A

IV magnesium sulphate
antihypertensives
blood products
timely delivery

36
Q

pre eclamptic angina

A

epigastric RUQ pain in a woman with pre-eclampsia
often represents hepatic involvement

37
Q

which anticonvulsant medication to use

A

MgSO4 - indictaed for women with severe pre-eclampsia to prevent seizures and reduce maternal mortallity

38
Q

corticosteroid therapy

A

corticcoteroids are indicated for women with severe pre-eclapmsia to enhance foetal lung maturity and reduce neomatal RDS
benefit does not last beyond 7 days

39
Q

post partum management of pre-eclampsia

A

clinical annd lab derangements recover within several days
HTN can persist for up to 3 months
monitor patient
continue MgO4 until BP stabilisation and adequate diuresis achieved
acute hypertensive therapy should be commenced if BP > 150/110 in the first 4 days post partum
advise follow up with GP
consider secondary causes of hypertension in pregnaancy

40
Q
A
41
Q

what is gestational hyprtension

A

new onset of hypertension arising after 20 weeks gestation
no additional maternal or fetal features of preeclampsia
resolves within 3 months post partum

42
Q

patients with pre-existing chronic hypertension

A

strong risk factor for the development of pre-eclampsia and requires close clinical surveillance

43
Q

essential hypertnsion

A

BP >140/90 preconception or developing prior to 20 weeks without an underlying cause
or normal BP controlled with antihyprtnsives

44
Q

secondary hypertsion

A

hypertnsion due to
- chronic kidney disease
- renal artery stenosis
- systemic disease with renal involvement eg. diabetes, SLE
- endocrine disorders
- coarctation of the aorta

45
Q

in acute severe pre-eclampsia, ddelivery must always be preceeded by

A

control of severe hypertension
attention to fluid status
correction of coagulopathy (usually thrombocytopaenia)
control of eclampsia, or prophylaxis

46
Q

agent of choice for the acute treatment of acute severe hyprtension

A

oral nifedipine 10mg
repeat dose after 30 minutes if there is inadequate response

47
Q

intravenous agent of choice for the acute treatment of acute severe hyprtension

A

IV labetolol
20-80mg bolus over 2 minutes
repeat every ten minutes prn

48
Q

third line for severe acute hypertension

A

hydralazine 5-10mg
first dose 5mg if fetal compromise
IV or IM administration

49
Q

principles of management of eclampsia

A
  1. resuscitation: IV access, oxygen by mask, MgSO4, midazolam may be given if the seizure is long
  2. prevention of further seizures: continue MgSO4
  3. control of hypertension
  4. delivery: close fetal monitoring, arrange delivery, there is no role for continued pregnancy after eclampsia
50
Q

strategies to prevent pre eclampsia

A

cacium supplimentation
low dose aspirin

51
Q

medication for high blood pressure during pregnancy

A

methydopa, labetolol, hydralazine, nifedipine

52
Q

HELLP syndrome

A

hemolysis, elevated liver enzymes and low platelet count
maternal mortality is 1-2%

53
Q

presentation of HELLP syndrome

A

thrombocytopaecia (common)
haemolysis (rare)
elevated liver enzymes ALT, LDH
epigastric or right upper quadrant pain (pre-eclamptic angina)

54
Q

management of HELLP syndrome

A

if the platelet count is sufficiently low to present. hazard for operative delivery, a platelet transfusion should be considered

55
Q
A

OBGYN 2023 (43 decks)

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