Pre_eclampsia_Flashcards
What is pre-eclampsia?
Pre-eclampsia is new hypertension with proteinuria occurring after 20 weeks gestation.
What are the prevention strategies for pre-eclampsia?
Measure BP and test urine for proteinuria at each antenatal appointment, use albumin:creatinine or protein:creatinine ratio to quantify proteinuria, and offer aspirin 75-150mg OD from 12 weeks gestation until delivery in women with high-risk or ≥2 moderate-risk factors.
What are the high-risk factors for pre-eclampsia?
High-risk factors include hypertensive disease in a previous pregnancy, pre-existing maternal disease (chronic hypertension, renal disease, diabetes, autoimmune disease).
What are the moderate-risk factors for pre-eclampsia?
Moderate-risk factors include first pregnancy, age >40 years, pregnancy interval of >10 years, BMI >35 at booking visit, family history of pre-eclampsia, and multiple pregnancy.
When should aspirin be offered to pregnant women to prevent pre-eclampsia?
Aspirin should be offered from 12 weeks gestation until delivery in women with 1 high-risk factor or ≥2 moderate-risk factors.
What are the indications for admission to the antenatal ward for pre-eclampsia?
Indications for admission include severe hypertension (BP >160/110mmHg), symptoms of severe late-stage disease, biochemical or haematological abnormalities, suspected fetal compromise, and adverse events suggested by PIERS or PREP-S models.
What monitoring is recommended for pre-eclampsia during pregnancy?
Monitoring includes BP every 2 days, blood tests (FBC, LFTs, U&Es) 2x/week, and ultrasound fetal surveillance every 2 weeks.
What are the first-line, second-line, and third-line antihypertensive treatments for pre-eclampsia?
First-line antihypertensive is labetalol, second-line is nifedipine, and third-line is methyldopa.
When should IV magnesium sulphate be considered in pre-eclampsia?
IV magnesium sulphate should be considered if features of severe pre-eclampsia are present and birth is planned within 24 hours.
What is the definitive treatment of pre-eclampsia?
The definitive treatment of pre-eclampsia is delivery.
When should delivery be arranged for pre-eclampsia?
Delivery should be arranged for 37 weeks gestation, or earlier if maternal or fetal indications arise.
What are the considerations for delivery before 34 weeks, between 34-36 weeks, and after 37 weeks in pre-eclampsia?
For delivery before 34 weeks: IV magnesium sulfate + course of antenatal corticosteroids. For delivery between 34-36 weeks: consider a course of antenatal corticosteroids. For delivery after 37 weeks: delivery is recommended.
What is the postnatal management for pre-eclampsia?
Postnatal management includes monitoring BP, continuing antenatal antihypertensive treatment if required, avoiding diuretics during breastfeeding, and follow-up with GP at 2 weeks and 6-8 weeks postnatally.
When should methyldopa be stopped postnatally?
Methyldopa should be stopped within 2 days after birth and changed to an alternative agent if necessary.
What follow-up is recommended for women with pre-eclampsia after discharge from the hospital?
Follow-up with GP at 2 weeks for medication review and again at 6-8 weeks to ensure resolution of hypertension.
