Pregnancy

Question 1

Pre-eclampsia
- Prevalence (%)
- Pathophysiology

Answer 1

Pre-eclampsia

• Prevalence (%)
  1. 5% of all pregnancies
• Pathophysiology
  1. Abnormal placentation
  2. Poor invasion of the tunica muscularis media

3. High resistance, low-flow uteroplacental circulation
4. Systemic inflammatory response
   - endothelial cell dysfunction

Question 2

Pre-eclampsia
- Risk factors

Answer 2

Pre-eclampsia
- Risk factors

1. Chronic HTN
   - previous pre-eclampsia
2. CKD/DM
3. Autoimmune disease
4. Nuliparity
5. Increased maternal age
6. Maternal BMI
7. FHx
8. High pregnancy interval
9. Multiple pregnancy

Question 3

Pre-eclampsia
- Clicinical features

Answer 3

Pre-eclampsia
- Clicinical features

1. HTN
   - 140/90
   - two occasions, 4 hours apart
2. Proteinuria
   - 300mg protein in 24hr urine
   - >30mg/mmol P:CR
3. 20wks +

Question 4

Pre-eclampsia
- Symptoms

Answer 4

Pre-eclampsia
- Symptoms

1. Headaches
   - frontal
2. Visual disturbance
   - blurred/double/halos/flashing lights
3. Epigastric pain
   - hepatic capsule distension/infarction
4. Odoema
   — sudden/non-dependent
5. Hyper-reflexia

Question 5

Pre-eclampsia
- Classification

Answer 5

Pre-eclampsia
- Classification

1. Mild
   - 140
2. Moderate
   - 150

Severe
- 160 +proteinuria
- 140+proteinuria + symptoms

Question 6

Pre-eclampsia
- Maternal Complications

Answer 6

Pre-eclampsia
- Complications

1. HELLP syndrome
   - haemolysis/liver enzames/low platelets
2. Eclampsia
3. AKI
4. DIC
5. ARDS
6. HTN
7. Cerebrovascular haemorrhage
8. Death

Question 7

Pre-eclampsia
- Fetal complications

Answer 7

Pre-eclampsia
- Fetal complications

1. Prematurity
2. Intrauterine growth restriction
3. Placental abruption
4. IU fetal death

Question 8

Pre-eclampsia
- DDx

Answer 8

Pre-eclampsia
- DDx

1. Essential HTN
   - Prior to 20wks
2. PIH
   - Pregnancy induced HTN
   - No significant protinuria
3. Eclampsia
   - Pre-eclampsia + seizure

Question 9

Pre-eclampsia
- Investigations

Answer 9

Pre-eclampsia
- Investigations

1. FBC
   - Low Hb
   - Low platelets
2. U&E
   - High urea & Cr
   - low urine output
3. LFTs
   - Raised ALT & AST

Question 10

Pre-eclampsia
- Mx aims

Answer 10

Pre-eclampsia
- Mx aims

1. Prevent eclampsia
2. Reduce complications
   - VTE
   - Anti-HTNs
   - Delivery

Question 11

Pre-eclampsia
- BP Mx
- ACEi use

Answer 11

Pre-eclampsia
- BP Mx

1. Labetalol
2. Nifedipine
3. Methyldopa
   - Alpha-agonist
4. ACEi
   - Contra-indicated

Question 12

Placental abruption
- Pathology
- Types

Answer 12

Placental abruption

• Pathology
  1. Rupture of maternal vessels
• Basal layer of endometrium
  2. Blood splits placental attachment from basal layer
  3. Rapid fetal compromise
• Types
  1. Revealed
• Bleeding drains through cervix
• Vaginal bleeding

2. Concealed
   - Bleeding remains within uterus
   - Retroplacental bleeding

Question 13

Placental abruption
- Risk factors

Answer 13

Placental abruption
- Risk factors

1. Prevous abruption
2. Pre-eclampsia and other hypertensives
3. Abnormal lie
4. Polyhydramnios
5. Abdominal trauma
6. Smoking/drug use
7. Bleeding in first trimester
8. Thrombophilia
9. Multiple pregnancy

Question 14

Placental abruption
- DDx

Answer 14

Placental abruption
- DDx

1. Placental praveia
2. Marginal placental bleed
3. Vasa praevia
   - vaginal bleeding+RoM+Fetal compromise
4. Uterine rupture
5. Local genital cause
   - benign/malignant lesion
   - infection

Question 15

Placental abruption
- Mx

Answer 15

Placental abruption
- Mx

0. Anti-D within 72 hours
   - if rhesus D negative
1. Emergency delivery
   - maternal/fetal compromise
2. Induction of labour
   - haemorrhage at term
   - no compromise
3. Conservative management
   - partial or marginal abruption