Pre-eclampsia and Hypetension in Pregnancy

Question 1

Define pre-eclampsia?

Answer 1

Hypertension at 20 weeks gestation WITH proteinuria

Question 2

Define normal, moderate and severe blood pressure ranges within pregnancy?

Answer 2

Normal - 140//90 mmHg
Moderate - 150//100 mmHg
Severe - 160//110 mmHg

Question 3

Name seven symptoms and signs of pre-eclampsia?

Answer 3

Headache
Visual disturbances - flashing lights - severe cases = papillodema
Hand/foot oedema (may be normal in pregnancy however if RAPID or very painful - severe cases = facial oedema
Pulmonary oedema
Tummy pain - RUQ/epigastric due to liver oedema
Vomiting
Nausea

Question 4

Name five moderate risk factors of developing pre-eclampsia?

Answer 4

Age (40+)
High BMI (35+)
Fhx
Nulliparous
Multiples

Question 5

Name five severe risk factors of developing pre-eclampsia?

Answer 5

SLE
Diabetes
CKD
Previous pre-eclampsia
Chronic hypertension

Question 6

State and describe the pneumonic attached to investigation results with pre-eclampsia?

Answer 6

HELLP =
Haemolysis
Elevated liver enzymes
Low platelets

Question 7

Name three complications to the mother with pre-eclampsia?

Answer 7

Eclampsia
DIC (via low platelets)
Stroke

Question 8

Name four complications to the foetus with pre-eclampsia?

Answer 8

IUGR
Pre-term (before 37 weeks)
Placental abruption
Hypoxia

Question 9

What investigations should be carried out with a suspicion of pre-eclampsia?

Answer 9

Urinalyis - bedside urine dipstix (prot-)
24 hour urine collection
PCR (protein-createnine ratio) - if above 30 is alarming
FBC (high haematocrit/low platelet)
U+E (increased createnine)
LFTs (increased ALT/ALKs)
Group and Save
If and when admitted monitor BP every 15 mins

Question 10

What are the treatment options for pre-eclampsia?

Answer 10

Lebetalol = first line
Nifedipine
Methyldopa

Question 11

What is the prophylaxis treatment for women identified as risk?

Answer 11

Aspirin - 75mg prophylaxis

Question 12

If baby is pre-term - 24-36 weeks what should be administered?

Answer 12

Steroids - Betamethasone 12mg x 2 - 24 hours apart to help aid foetal surfactant production

Question 13

What should be administered if suspected or prevention of seizures?

Answer 13

MgSO4