Preeclampsia ☺️

Question 1

Risk factors

Pathophysiology

Answer 1

24wks onwards

• past PET, FHx PET
• multigravid, nulliparous
• chronic HTN, high BMI, DM
• high maternal age
• APS

Placental hypoperfusion due to defective spiral artery remodelling => pro inflammatory cytokines
Systemic VC, endothelial dysfunction => HTN, end organ damage
Leads to HELLP (hemolysis, elevated liver enzymes, low platelets)

Question 2

Signs and symptoms

• in mother
• in baby

Answer 2

Mother
HTN => blurry vision, severe headaches
Proteinuria on dipstick
Peripheral edema => weight gain
N+V, abdo pain

May lead to

• seizures
• HTN, elevated liver enzymes, low platelets
• stroke

Unborn
-IUGR

Question 3

Management

• at risk, symptomatic
• chronic HTN
• proteinuria, no HTN

Answer 3

Prevention - 75mg of aspirin from 12wks onwards
If they have symptoms => hospital

Lifestyle changes to manage BP => target 135
Stop ACEi, ARB => increased risk of AE on baby in 2nd, 3rd trimester
Stop thiazides
Specialist support for alternatives
-1st line labetolol (alt, nifedipine, methyldopa)

Preeclampsia is still a possibility, proteinuria 2+ => specialist assessment even if no other symptoms, UTI likely
-UTI, if leukocytes nitrites +ve, proteinuria 1+ => MSU, follow up in a week