Preeclampsia

Question 1

What is severe preeclampsia?

Answer 1

• Severe hypertension - systolic >160, diastolic >110
• Worsening symptoms of preeclampsia
• Worsening preeclampsia bloods
• HELLP Syndrome (hemolysis, elevated liver enzymes, low platelets)

Question 2

What is the pathophysiology of preeclampsia?

Answer 2

abnormal placenta = spiral arteries fibrosis (scarring/narrow) = reduced blood flow = poorly professed placenta = pro inflammatory proteins enter maternal circulation = endothelial cell dysfunction and kidneys to retain salt = hypertension and other organ damage

Question 3

What is the pathophysiology to cause hypertension in preeclampsia?

Answer 3

abnormal placenta = spiral arteries become fibrosis = reduced blood flow causes poorly perfused placenta to produce pro-inflammatory proteins that enter the maternal circulation and cause endothelial cell damage and vasoconstriction causing the kidneys to retain salt = hypertension

Question 4

What is the pathophysiology to cause blurred vision, flashing lights, and scotoma in preeclampsia?

Answer 4

Vasoconstriction = reduced blood flow to the retina

Question 5

What are major risk factors for preeclampsia?

Answer 5

• Previous history of preeclampsia
• Family history of preeclampsia (mother/sister)
• ART
• Preexisting diabetes (type 1 or 2)
• Renal disease
• Antipropspholipid syndrome
• Chronic hypertension
• Multiple pregnancy
• Chronic auto immune disease

Question 6

Signs and symptoms of preeclampsia?

Answer 6

• Blurred vision
• Flashing lights
• Headache
• Epigastric pain
• Hypertension
• Protein in urine
• Oedema
• Altered mental state
• Feeling unwell
• Nausea/vomiting
• Hyperreflexia

Question 7

What is recommended for women with a history of preeclampsia?

Answer 7

Low-dose aspirin commenced from 12 - 16 weeks and ceased at 36 weeks (due to blood thinning effect) at 100mg x1 a day taken in the evening (obstetric prescribed) and to refer before 16 weeks gestation

Question 8

Low dose aspirin contraindications?

Answer 8

Allergy to aspirin, peptic ulcer, and asthma induced by non-steroidal anti-inflammatory drugs

Question 9

What does the referral guidelines say for preeclampsia diagnosed in the current pregnancy?

Answer 9

Transfer of care

Question 10

What does the referral guidelines say for a previous history of preeclampsia with significant FGR or preeclampsia that required birth <34 weeks?

Answer 10

Consult before 16 weeks gestation

Question 11

What dose of calcium should be considered for women with preeclampsia (obstetric)?

Answer 11

1.5 - 2.0mg of oral elemental calcium

Question 12

Who should calcium supplementation be considered for?

Answer 12

Women with major risk factors for preeclampsia

Question 13

What are common antihypertensive medications?

Answer 13

labetalol, nifedipine, methyldopa

Question 14

What dose of labetalol should be given and what are the contraindications?

Answer 14

100mg stat then 100 - 200mg 3 - 4 times daily. Contraindication for women with asthma

Question 15

What dose of nifedipine should be given?

Answer 15

10 - 30mg slow release 2x daily

Question 16

What dose of methyldopa should be given and what are the contraindications?

Answer 16

500mg stat then 250 - 500mg 3x daily. Contraindications = avoid postnatally

Question 17

Magnesium sulphate dose in women with eclampsia

Answer 17

4g loading dose in normal saline over 15 - 20 minutes then 1 - 2 g/hr

Question 18

Signs of magnesium sulphate toxicity?

Answer 18

Respiratory depression, breathing difficulties, poor reflexes, confusion, weakness, flushing, sweating, lowered bp

Question 19

Main cause of eclampsia?

Answer 19

Widespread endothelial damage

Question 20

Management of eclamptic seizure

Answer 20

Call for help
Consult with obstetric team
Ensure patient airway - roll to the left side to decrease risk of aspiration and will improve uterine blood flow by receiving obstruction to vena cava by the grand uterus
Administer 100% oxygen at 6-8 L/min
O2 monitoring