Pre-eclampsia, eclampsia, HELLP syndrome Flashcards
What is pre-eclampsia
Pregnancy induced HPTN with e nd organ dysfunction - proteinuria
What is pregnancy induced HPTN or gestational HPTN
HPTN occuring after 20 weeks gestation
What is eclampsia
Seizures occur as a result of pre-eclampsia
Why does pre-eclampsia happen after 20 weeks
When spiral arteries of placenta form abnormally -> high vascualr resistnace
What is the triad of pre-eclampsua?
HPTN
Proteinuria
Oedema
What can pre-eclampsia lead to?
Maternal organ dmaage
Foetal growth restriction
Seizures
Early labour
Death
What forms chorionic villi?
Syncytiotrophoblast, the outermost layer of the blastocyst -> finger like projections into endometrium = chorionic villi
What contatin feotal blood vessles
Chorionic villi
What makes spiral arteries more fragile
Trophoblast invasion of the endometrium send signals - reduces vascular resistance of sprial arteries
When do lacunae form
20 weeks gestation
How are lacunae formed
Trophoblast signals vascular resistance spiral arteries to decrease, blood flow to them increases and they break down leaving pools of blood - lacunae. Maternal blood -> uterine arteries -> lacunae -> uterine veins
What causes pre-eclampsia
High vascular resistance in spiral arteries and poor perfusion of placenta -> oxidatice stress in placenta ->inflam chemicals -> systemic infalmmation and impaired endothelial function in blood vessels
High risk factors for pre-eclampsia
Pre-existing HPTN
Prev HPTN in pregnancy
Existing AI conditions (SLE)
Diabetes
CKD
Moderate risk factors
> 40
BMI >35
10 years since prev pregnancy
Multiple pregnancy
First pregnancy
FH of pre-eclampsia
When are women offered aspirin from 12 weeks gestation until birth
One high risk factor
More than one moderate risk factors
Symptoms of pre-eclampsia
Headache
Visual disturbance
Nausea and vomitting
Upper abdominal or epigastric pain - due to liver swelling
Oedema
Reduced urine output
Brisk reflexes
What is the level for diagnosis of pre-eclampsia
Systolic >140 mmHg
Diastolic >90 mmHg
PLUS any of
-Proteinuris
-Organ dysfunction
-Palcental dysfunction
Signs of organ dysfunction
Raised creatinine
Elevated liver enzymes
Seizures
Thrombocytopenia
Haemolytic anaemia
Placental dysfunction ifentification
Foetal grwoth restriciton
Abnormal doppler studies
Urine protein:creatinine ratio level
> 30mg/mmol significant
Urine albumin:creatinine ration level
> 8mg/mmol significant
Proteinuria level on urine dipstick that counts for pre-eclampsia
+1 or more on urine dipstick
What is placental growth factor
Protein released by placents stimulating development of new blood vessels
Low in pre-eclampsua
WHat does NICE recommend about testing placental growth factor
Test once between 20 and 35 weeks gestation to rule out pre-eclampsia if suspected
What is used for prophylaxis against pre-eclampsia
Aspirin
What is monitored at every antenatal appointment for evidence of pre-eclampsia
BP
Symptoms
Urine dipstick for proteinuria
When admit a pregnant woman with high BP
> 160/110mmHg
What is the aim for treating HPTN in pregnancy
to get to 135/85 mmHg
How to monitor gestational HPTN without proetinuria
Urine dipstick testing at least weekly
Monitoring of blood tests weekly - FBC, liver enzymes, renal profile
Monitoring foetal growth by serial growth scans
PIGF testing on one occasion
What scoring systems arae used to determine whether to admit the woman
fullPIERS
PREP-S
What extra things are done when pre-eclampsia diagnosed vs gestational HPTN
fullPIERS or PREP-S
BP monitored 48 hourly
US monitor of foetus, amniotic fluid and dopplers 2 weekly
No need for urine dips
Medical management pre-eclampsia options
Labetolol
Nifedipine
Methyldopa
Medical management in sec pre or eclmapsia
IV hydralazine
IV mg sulphate
Fluid restriction - avoid fluid overload
What is first line for pre-eclampsia
Labetolol
After first line meds for pre-eclampsia
Nifedipine - second line
Methyldopa - 3rd line
What drug needs to be stopped within two dyas of birth
methyldopa
What drug is used as an antiHPTNsive in critical care in pre-eclampsia or eclampsia
IV hydralazine
What is given in labour and 24 hours after to prevent seizures
IV mg sulphate
Why is there a risk of fluid overload in pre-eclampsia/eclampsia
When is planned early birth necessary
BP cannot be controlled or complications occur
Give corticosteroids
What medical treatmnet to switch to after delivery for pre-eclampsia
Enalapril - 1st line
Nifedipine or amlodipine - 1st line in black african or caribbean patients
Labetolol or atenolol
Treatment for seizures ass with eclampsia
IV mg sulphate
What is HELLP syndrome
Features that occur as complication of pre eclampsia and eclmapsia
Haemolysis
Elevated Liver enzymes
Low Platelets
What mechanism causes pre-eclampsia
Oxidatiev stress leading to inflammation
Increased vascular permeability
Increased prothrombic factors
Increased platelet aggregation
Vasoconstriction
End organ dysfunction/damage
What is pre-eclampsia complication
HELLP syndrome
Baby needs to be out
When are people induced with pre-eclampsia even if its well controlled
37 weeks
Can you carry til term with well ctonrolled hypertension
yes
Why is it hard to do a C section with HELLP
Problems with coagulation
What effect does pre-eclampsia have on labour
Makes it really quick
Full labour in 1-2 hours
