Pre-Eclampsia History & Counselling Flashcards
Give the diagnostic criteria for pre-eclampsia
After 20 weeks gestation:
1) BP ≥140/120
2) Proteinuria:
- TWO readings of ++ on dipstick, or
- PCR≥30 mg/mmol, or
- ≥300mg protein in 24hr urine collection
Symptoms of pre-eclampsia?
- Headache (due to cerebral oedema)
- Swelling of hands and face
- Visual disturbances e.g. blurred vision, flashing lights
- Seizures (eclampsia)
- Reduced urine output
- Abdo pain
- N&V
Signs seen in pre-eclampsia?
- HTN
- Oedema (hands and face)
- Epigastric/RUQ tenderness
- Hyper-reflexia and clonus (increased risk of eclamptic seizure)
- Papilloedema
3 differentials for pre-eclampsia are:
1) Chronic HTN
2) Gestational HTN
3) Pre-eclampsia superimposed on chronic hypertension
Define each
1) HTN that occurs before 20 weeks gestation or persists after 12 weeks postpartum
2) Gestational HTN that occurs after 20 weeks gestation without any co-existing complications
3) HTN that already exists but worsens after 20 weeks gestation alongside the development of co-existing complications.
What are some MATERNAL complications of pre-eclampsia?
- Eclampsia: obstetric emergency
- HELLP syndrome: can lead to DIC
- Placental abruption
- CVS complications: MI, stroke (due to raised BP)
- Multi-organ dysfunction: with progressive worsening to multi-organ failure.
How long after delivery can eclampsia occur?
Up to 10 days
Blood film results in HELLP?
Schistocytes (fragmented RBCs)
What are some FOETAL complications of pre-eclampsia?
- Preterm birth
- IUGR (and maybe stillbirth), as baby not receiving adequate blood, oxygen and nutrients from placenta
Investigations in pre-eclampsia?
1) BP & obs
2) CTG / foetal heart auscultation
3) Urinalysis (for protein)
4) Bloods: FBC, U&Es, LFTs, clotting profile
5) PIGF testing (will likely be low)
Key aspect of prevention of pre-eclampsia?
Aspirin 75-150mg daily from 12 weeks gestation until birth
Overview of management in pre-eclampsia?
1) Consultant led care: deemed a ‘high risk’ pregnancy
2) Control BP –> Oral labetalol (or nifedipine if asthmatic)
3) Admit if severe (≥160/110)
4) VTE prophylaxis e.g. LMWH, anti-embolism stockings
5) Early delivery (if severe)
Purpose of antihypertensives in pre-eclampsia mx?
reduce CVS risk (particularly stroke risk)
How long after birth will antihypertensives be continued for in pre-eclampsia?
Up to 6-12 weeks postpartum
Regular monitoring in pre-eclampsia?
Close monitoring of both mother and fetus is key to reducing the risk of adverse outcomes associated with pre-eclampsia.
Regular screening for:
1) Blood pressure assessment
2) Proteinuria
3) Blood tests including FBC, U&Es and LFTs
Regular foetal monitoring:
1) CTG: foetal heartbeat
2) US: assessment of fetal growth and amniotic fluid levels (can cause IUGR)
3) Umbilical artery Doppler velocimetry: assessment of placental and fetal circulation.
When is planned early birth (<37w) indicated in pre-eclampsia?
BP ≥160/110
Explanation of pre-eclampsia to pt:
Pre-eclampsia is a hypertensive disorder of pregnancy caused by abnormal placentation leading to a maternal inflammatory response.
Most patients with pre-eclampsia are asymptomatic and diagnosed as a result of routine antenatal screening which identifies hypertension and/or proteinuria.
Close monitoring of both mother and fetus is key to reducing the risk of adverse outcomes associated with pre-eclampsia.
Risk factors for pre-eclampsia?
High risk:
1) HTN during previous pregnancy
2) CKD
3) Autoimmune condition e.g. SLE, APL
4) T1 or T2DM
5) Chronic HTN
Moderate risk:
1) Increasing maternal age (≥40 y/o)
2) 1st pregnancy
3) Pregnancy interval >10 years
4) BMI >35
5) FH of pre-eclamspia
6) Multiple pregnancy
How often are blood tests performed in pre-eclampsia?
Mild (140/90 - 149/99) –> 2x a week
Moderate (150/100 - 159/109) –> 3x a week
Severe (≥160/110) –> admit
Who is offered aspirin for HTN/pre-eclampsia prophylaxis?
≥1 high risk factor
or
≥2 moderate risk factors
When is delivery typically recommended in pre-eclampsia?
37th to 38th week
What % of pregnancies does pre-eclampsia affect?
5-8%
