Pre-Eclampsia History & Counselling

Question 1

Give the diagnostic criteria for pre-eclampsia

Answer 1

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

Question 2

Symptoms of pre-eclampsia?

Answer 2

• 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

Question 3

Signs seen in pre-eclampsia?

Answer 3

• HTN
• Oedema (hands and face)
• Epigastric/RUQ tenderness
• Hyper-reflexia and clonus (increased risk of eclamptic seizure)
• Papilloedema

Question 4

3 differentials for pre-eclampsia are:

1) Chronic HTN

2) Gestational HTN

3) Pre-eclampsia superimposed on chronic hypertension

Define each

Answer 4

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.

Question 5

What are some MATERNAL complications of pre-eclampsia?

Answer 5

• 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.

Question 6

How long after delivery can eclampsia occur?

Answer 6

Up to 10 days

Question 7

Blood film results in HELLP?

Answer 7

Schistocytes (fragmented RBCs)

Question 8

What are some FOETAL complications of pre-eclampsia?

Answer 8

• Preterm birth
• IUGR (and maybe stillbirth), as baby not receiving adequate blood, oxygen and nutrients from placenta

Question 9

Investigations in pre-eclampsia?

Answer 9

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)

Question 10

Key aspect of prevention of pre-eclampsia?

Answer 10

Aspirin 75-150mg daily from 12 weeks gestation until birth

Question 11

Overview of management in pre-eclampsia?

Answer 11

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)

Question 12

Purpose of antihypertensives in pre-eclampsia mx?

Answer 12

reduce CVS risk (particularly stroke risk)

Question 12

How long after birth will antihypertensives be continued for in pre-eclampsia?

Answer 12

Up to 6-12 weeks postpartum

Question 13

Regular monitoring in pre-eclampsia?

Answer 13

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.

Question 14

When is planned early birth (<37w) indicated in pre-eclampsia?

Answer 14

BP ≥160/110

Question 15

Explanation of pre-eclampsia to pt:

Answer 15

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.

Question 16

Risk factors for pre-eclampsia?

Answer 16

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

Question 17

How often are blood tests performed in pre-eclampsia?

Answer 17

Mild (140/90 - 149/99) –> 2x a week

Moderate (150/100 - 159/109) –> 3x a week

Severe (≥160/110) –> admit

Question 18

Who is offered aspirin for HTN/pre-eclampsia prophylaxis?

Answer 18

≥1 high risk factor

or

≥2 moderate risk factors

Question 19

When is delivery typically recommended in pre-eclampsia?

Answer 19

37th to 38th week

Question 20

What % of pregnancies does pre-eclampsia affect?

Answer 20

5-8%