Preeclampsia

Question 1

What is the definition of preeclampsia?

Answer 1

Pregnancy induced:
Hypertension (after 20 weeks'),  >140/90 (or >30/15 over baseline)
Proteinuria, >300mg/24hrs
Generalised oedema 
Multisystem dysfunction

Question 2

What Ix do you do for preeclampsia?

Answer 2

Maternal: FBE, coagulation studies, renal function (dipstick and urinary protein/Cr ratio), LFTs
Fetal: CTG, U/S

Question 3

What are some indicators of severe preeclampsia?

Answer 3

Extreme HTN
Headache
Visual disturbances
Pulmonary oedema
Upper abdominal pain
Worsening proteinuria 
Papilloedema

Question 4

What is the definition of eclampsia?

Answer 4

Seizures in the context of preeclampsia

Question 5

How is preeclampsia managed?

Answer 5

Prevention: calcium, low dose aspirin
Admission
Stabilisation
Multidisciplinary care
Fetal monitoring
BP control: methyldopa, labetalol, nifedipine 
Fluid balance 
Seizure prophylaxis 
Neuronal stabilisation and fetal neuroprotection: MgSO4
Delivery!
Postpartum observation

Question 6

What are some complications of preeclampsia?

Answer 6

Cardiac: severe HTN, pulmonary oedema
Renal: oliguria, renal failure
Hepatic: hepatic rupture
Haem: DIC, haemolysis, thrombocytopenia
Neurological: eclampsia, cerebral haemorrhage
Uroplacental: abruption, fetal distress, fetal death

Question 7

What is HELLP syndrome?

Answer 7

A variant of severe preeclampsia where HTN may not be the predominant feature
Characterised by haemolysis, elevated liver enzymes and low plt count

Question 8

What are symptoms and signs of HELLP syndrome?

Answer 8

Malaise 
Epigastric pain
RUQ tenderness
N/V
Headache
Oedema