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.
What should be done if hypertension and proteinuria do not resolve within 6 weeks postnatally?
If hypertension and proteinuria do not resolve within 6 weeks, consider the diagnosis of chronic hypertension or renal disease.
What are the risk factors for pre-eclampsia recurrence?
Risk factors for recurrence include previous hypertensive disease in pregnancy, multiple pregnancy, diabetes mellitus, kidney disease, first pregnancy, obesity, age over 35 or under 20, family history, PCOS, and IVF.
