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Obstetrics & Gynaecology > Preeclampsia > Flashcards

Preeclampsia Flashcards

1
Q

What hypertensive drugs are contraindicated in pregnancy?

A

ACEi and diuretics

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2
Q

Management of PET and delivery plan?

A

***delaying delivery is not warranted byond 38 weeks

Between 34-37 monitoring as elective delivery is associated with poorer fetal outcomes

<34 conservative management +corticosteroids

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3
Q

What drugs can be given prediagnosis to reduce the risk (in a high risk woman)

A
  • Low dose aspirin i.e 100mg daily early in pregnancy can reduce the risk of preeclampsia by around 15%.
  • Women with low calcium intake should be offered calcium supplements ,this reduces the risk of preeclampsia by about 60%
  • Low dose multivitamin/folic acid may help reduce preeclampsia occurance
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4
Q

What is HELLP syndrome

A

Haemolysis, elevated liver functions, low platelets

  • Serious complicaion of PET
  • Can present mildly such as abdominal pain, nausea , vomiting malaise, headaches, oedema , visual disturbances
  • The diagnosis of HELLP syndrome should be considered in any pregnant patient with new-onset epigastric/upper abdominal pain until proven otherwise
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5
Q

Diagnostic criteria for HELLP

A
  • ELevated AST/ALT <70
  • LDH serum lactate >600IU/L
  • Platlet count <100x109
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6
Q

__% of eclamptic seizures occur after delivery

A

40%

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7
Q

Pathophysiology of PET

A
  1. When the trophoblastic cells dont growth properly into the placenta, leading to a maladaption of some of the spiral arteries supplying the placenta to dilate.
  2. This causes suboptimal placental perfusion which can cause the placenta to release pro-inflammatory substrate
  3. This can cause vasocontriction
    • Poor kidney perfusion, liver swelling
  4. And endothelial dysfunction
    • oedema, HTN, cerebral oedema/neuro symptoms
  5. As plasma volume falls due to fluid leakage the coagulation system is activat, and DIC

This is thought to be due to a combination of genetic and environmental influences as well as the maternal response

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8
Q

Clinical Feature of PET

A
  • Occuring >20 weeks gestation
  • Hypertension >140/90
    • in previously normotensive woman, 4 hours apart
  • Headache (frontal) (40%)
  • Visual disturbance
  • Oedema
  • Epigastric or RUQ pain (?HELLP)
  • Reduced fetal movements
  • Reduced fetal growth
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9
Q

Risk factors for developing PET

A
  • Nulliparity
  • Multiple pregnancy
  • Maternal age >35 or <20
  • Family history
  • Previous PET
  • Obesity
  • Renal Disease
  • Diabetes
  • AI disease (antiphospholipid)
  • Chronic HTN
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10
Q

What would you see with PET renal involvement?

A
  • significant proteinuria (+1)
    • Confirmed by
      1. Spot urine preotein/Creatinine ration >30mg/mmol OR
      2. Plasma Creatinine >90micromol/l
  • Oliguria <80ml/four hours
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11
Q

What would you see with PET haemoatological involvement

A
  • Thrombocytopenia
  • haemolysis
  • DIC
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12
Q

What would you see with PET liver involvement

A
  • Raised serum transaminases
  • Severe epigastric or RUQ pain
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13
Q

What could you see with PET neurological invovlement?

A
  • Eclampsia/convulsions
  • Hypereflexia with sustained clonus
  • severe frontal headache
  • Persistant visual disturbances
  • Stroke
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14
Q

General involvement as a result of PET

A
  1. Pulmonary oedema
  2. Fetal growth restriction
  3. Placental abruption
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15
Q

What investigations would you want to determine/rule out potenital PET

A
  1. Repeat BP after 4 hours
  2. Urine tests:
    • MSU
    • Dipstick screening + PCR
    • Also need a 24hr collection >0.3g/24hr
  3. Blood tests to order
    • FBC: platelets
    • LFT: albumin, AST, ALT (****NORMAL RANGE LOWER IN PREGNANCY)
    • G+H
  4. Fetal wellbeing assessment:
    • Fetal USS + measurements + liquor
    • CTG
    • Umbilical artery doppler
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16
Q

What could be your differential diagnosis outside of PET?

A
  • Chronic HTN
  • GEstational HTN
  • Epilepsy
  • Antiphospholipid Syndrome
  • Renal disease
  • Liver disease
  • …….
17
Q

Why would you admit

A
  • If they were symptomatic for PET (headaches, visual change, epigastric or RUQ pain)
  • proteinuria + HTN >160/100
  • Change in blood tests
  • APH
  • Reduced fetal movements
  • Uterine activity
18
Q

What does inpatient maternal monitoring of a PET patient include?

A
  • Clincial assessment of symptoms
  • 4-6hourly BP (overnight 8hrs acceptable) and compare to <20week readings
  • Daily urinalysis
  • MSU (at least once)
  • 2/week FBC, LFT, CR
  • Coags should be done if platelets are falling (<100), abnormal LFTs or ?placental abruption
  • Uterine +liver tenderness, oedema, hyperreflexia,and fundal height
  • Serial fetal GROW scans

Increase investigation frequency if there are any concerns

19
Q

What can be given therapeutically in high risk women?

A
  • Aspirin has show to reduce risk by 15%
    • 100mg OD start ideally 12-16weeks
  • Calcium in low intake women can reduce risk by 60%
    • 1-1.5g OD
  • Low dose multivitamin/folic acid may help

Anti-hypertensives: considerif BP consistently above 140/90-160/100

  • Nifedipine
  • Labetalol
  • Metoprolol
  • Methyldopa
  • Mg S
20
Q

Sudden onset HTN >170/110.

What antihypertensive do we use?

A

SA Nifedipine or iv labetalol

Methyldopa or labetalol can be used for >160/100

21
Q

Women with eclampsia, what antihypertensive can we use?

A

MgS as a loading dose (4g / 20 mins) followed by maintenence infusion (1-2g/hr) for 24-48hrs

If seizure continues you can give a IV benzodiazepine (not reccomended in pregnancy usually)

22
Q

Do we need to continue management after delivery, what the main risk to mother

A

yes and the main risk is fluid overload

23
Q

Gestational HTN vs Chronic HTN vs Pre-eclampsia

A

Gestational HTN:

  • New onset HTN after 20 weeks gestation
  • No PET features
  • 25% develop PET later

Chronic HTN:

  • HTN prior to pregnancy or <20weeks gestation

Pre-eclampsia:

  • Multisystem progressive disorder
  • Dx >20 weeks
  • Involvement of more then one organ system and/or the fetus
  • ***can be superimposed on chronic HTN
24
Q

When should

A

Obstetrics & Gynaecology (22 decks)

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