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Reproductive Health > Pre-eclampsia, eclampsia, HELLP syndrome > Flashcards

Pre-eclampsia, eclampsia, HELLP syndrome Flashcards

1
Q

What is pre-eclampsia

A

Pregnancy induced HPTN with e nd organ dysfunction - proteinuria

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2
Q

What is pregnancy induced HPTN or gestational HPTN

A

HPTN occuring after 20 weeks gestation

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3
Q

What is eclampsia

A

Seizures occur as a result of pre-eclampsia

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4
Q

Why does pre-eclampsia happen after 20 weeks

A

When spiral arteries of placenta form abnormally -> high vascualr resistnace

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5
Q

What is the triad of pre-eclampsua?

A

HPTN
Proteinuria
Oedema

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6
Q

What can pre-eclampsia lead to?

A

Maternal organ dmaage
Foetal growth restriction
Seizures
Early labour
Death

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7
Q

What forms chorionic villi?

A

Syncytiotrophoblast, the outermost layer of the blastocyst -> finger like projections into endometrium = chorionic villi

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8
Q

What contatin feotal blood vessles

A

Chorionic villi

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9
Q

What makes spiral arteries more fragile

A

Trophoblast invasion of the endometrium send signals - reduces vascular resistance of sprial arteries

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10
Q

When do lacunae form

A

20 weeks gestation

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11
Q

How are lacunae formed

A

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

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12
Q

What causes pre-eclampsia

A

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

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13
Q

High risk factors for pre-eclampsia

A

Pre-existing HPTN
Prev HPTN in pregnancy
Existing AI conditions (SLE)
Diabetes
CKD

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14
Q

Moderate risk factors

A

> 40
BMI >35
10 years since prev pregnancy
Multiple pregnancy
First pregnancy
FH of pre-eclampsia

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15
Q

When are women offered aspirin from 12 weeks gestation until birth

A

One high risk factor
More than one moderate risk factors

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16
Q

Symptoms of pre-eclampsia

A

Headache
Visual disturbance
Nausea and vomitting
Upper abdominal or epigastric pain - due to liver swelling
Oedema
Reduced urine output
Brisk reflexes

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17
Q

What is the level for diagnosis of pre-eclampsia

A

Systolic >140 mmHg
Diastolic >90 mmHg
PLUS any of
-Proteinuris
-Organ dysfunction
-Palcental dysfunction

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18
Q

Signs of organ dysfunction

A

Raised creatinine
Elevated liver enzymes
Seizures
Thrombocytopenia
Haemolytic anaemia

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19
Q

Placental dysfunction ifentification

A

Foetal grwoth restriciton
Abnormal doppler studies

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20
Q

Urine protein:creatinine ratio level

A

> 30mg/mmol significant

21
Q

Urine albumin:creatinine ration level

A

> 8mg/mmol significant

22
Q

Proteinuria level on urine dipstick that counts for pre-eclampsia

A

+1 or more on urine dipstick

23
Q

What is placental growth factor

A

Protein released by placents stimulating development of new blood vessels
Low in pre-eclampsua

24
Q

WHat does NICE recommend about testing placental growth factor

A

Test once between 20 and 35 weeks gestation to rule out pre-eclampsia if suspected

25
Q

What is used for prophylaxis against pre-eclampsia

A

Aspirin

26
Q

What is monitored at every antenatal appointment for evidence of pre-eclampsia

A

BP
Symptoms
Urine dipstick for proteinuria

27
Q

When admit a pregnant woman with high BP

A

> 160/110mmHg

28
Q

What is the aim for treating HPTN in pregnancy

A

to get to 135/85 mmHg

29
Q

How to monitor gestational HPTN without proetinuria

A

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

30
Q

What scoring systems arae used to determine whether to admit the woman

A

fullPIERS
PREP-S

31
Q

What extra things are done when pre-eclampsia diagnosed vs gestational HPTN

A

fullPIERS or PREP-S
BP monitored 48 hourly
US monitor of foetus, amniotic fluid and dopplers 2 weekly
No need for urine dips

32
Q

Medical management pre-eclampsia options

A

Labetolol
Nifedipine
Methyldopa

33
Q

Medical management in sec pre or eclmapsia

A

IV hydralazine
IV mg sulphate
Fluid restriction - avoid fluid overload

34
Q

What is first line for pre-eclampsia

A

Labetolol

35
Q

After first line meds for pre-eclampsia

A

Nifedipine - second line
Methyldopa - 3rd line

36
Q

What drug needs to be stopped within two dyas of birth

A

methyldopa

37
Q

What drug is used as an antiHPTNsive in critical care in pre-eclampsia or eclampsia

A

IV hydralazine

38
Q

What is given in labour and 24 hours after to prevent seizures

A

IV mg sulphate

39
Q

Why is there a risk of fluid overload in pre-eclampsia/eclampsia

A
40
Q

When is planned early birth necessary

A

BP cannot be controlled or complications occur
Give corticosteroids

41
Q

What medical treatmnet to switch to after delivery for pre-eclampsia

A

Enalapril - 1st line
Nifedipine or amlodipine - 1st line in black african or caribbean patients
Labetolol or atenolol

42
Q

Treatment for seizures ass with eclampsia

A

IV mg sulphate

43
Q

What is HELLP syndrome

A

Features that occur as complication of pre eclampsia and eclmapsia
Haemolysis
Elevated Liver enzymes
Low Platelets

44
Q

What mechanism causes pre-eclampsia

A

Oxidatiev stress leading to inflammation
Increased vascular permeability
Increased prothrombic factors
Increased platelet aggregation
Vasoconstriction
End organ dysfunction/damage

45
Q

What is pre-eclampsia complication

A

HELLP syndrome
Baby needs to be out

46
Q

When are people induced with pre-eclampsia even if its well controlled

A

37 weeks

47
Q

Can you carry til term with well ctonrolled hypertension

A

yes

48
Q

Why is it hard to do a C section with HELLP

A

Problems with coagulation

49
Q

What effect does pre-eclampsia have on labour

A

Makes it really quick
Full labour in 1-2 hours

Reproductive Health (69 decks)

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