Preeclampsia and Eclampsia

Question 1

What is the underlying pathophysiology in pre-eclampsia?

Answer 1

• Poor placental implantation
• Normal BP in pregnancy decreases - spiral arteries are a hugely low resistance circuit. Drop in early pregnancy (e.g. 16 weeks) indicates good placental implantation. The opposite can indicate poor implantation with its inherent risks

Question 2

If a woman has hypertension and requires treatment for this while thinking of becoming pregnant, what medications are suitable?

Answer 2

• Methyldopa (aldomet)
• Labetalol (after 20 weeks)

Question 3

Which women should be considered for pre-eclampsia prophylaxis? What is this?

Answer 3

• Aspirin
• Women at increased risk for pre-eclampsia (hypertension, CKD, diabetes, SLE or other autoimmune disease, previous pre-eclampsia, increased age) OR
• More than 1 moderate risk factor (primigravida, > 40, >10 years since last pregnancy, BMI > 35, FHx pre-eclampsia, multiple pregnancy)

Question 4

How should mild gestational hypertension be treated?

Answer 4

• Consider admission if unusual reading (?developing currently), but not necessary
• Check BP twice weekly
• Do not treat blood pressure
• Consider blood tests/growth scan
• If IUGR
  
  • Growth scan 2-weekly, AFI twice-weekly and FHR twice-weekly

Question 5

If a woman develops severe hypertension during pregnancy, outline your management

Answer 5

• Admit
• Bloods - FBE (Hct, Hb, platelets), UECs, LFTs (AST, ALT [ALP raised due to placenta]), uric acid
• Stabilisation - blood pressure (methyldopa, labetalol, nifedipine, hydralazine)
• Continuous CTG during this - risk of placental perfusion decrease
• Steroids
• MgSO4
• Anaesthetic - don’t fluid load before spinal/epidural
• Deliver

Question 6

What is the treatment for eclampsia? What is the antidote for this?

Answer 6

• MgSO4
  
  • ICU post-partum while on this infusion - monitor reflexes and RR. Calcium gluconate is the antidote if overdosed
  • No diuretics or fluid overdose in ICU! Strict fluid monitoring
  • BP checks hourly
  • Bloods daily
  • Urine protein at 6 weeks

Question 7

If a woman develops pre-eclampsia during one pregnancy, what is her chance of developing it in subsequent pregnancies?

Answer 7

• 50%
• Higher if partner changed