Pregnancy Complications

Question 1

What is PET?

Answer 1

Pre-eclampsia describes the emergence of high blood pressure during pregnancy that may be a precursor to a woman developing eclampsia and other complications. It is classically a triad of 3 things:
new-onset hypertension
proteinuria
oedema

Question 2

What are the features of PET?

Answer 2

New-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy, AND 1 or more of the following:
proteinuria
other organ involvement (see list below for examples): e.g. renal insufficiency (creatinine ≥ 90 umol/L), liver, neurological, haematological, uteroplacental dysfunction

Question 3

How can women prevent hypertension in pregnancy?

Answer 3

If one high risk factor or two low risk factors, prescribe aspirin 75mg to reduce VTE risk from 12 weeks

Question 4

How is PET treated?

Answer 4

oral labetalol is now first-line following the 2010 NICE guidelines. Nifedipine (e.g. if asthmatic) and hydralazine

Question 5

How is eclampsia treated?

Answer 5

Magnesium sulphate for prevention and treatment of seizures

IV bolus of 4g over 5-10 minutes should be given followed by an infusion of 1g / hour

urine output, reflexes, respiratory rate and oxygen saturations should be monitored during treatment

respiratory depression can occur: calcium gluconate is the first-line treatment for magnesium sulphate induced respiratory depression
treatment should continue for 24 hours after last seizure or delivery (around 40% of seizures occur post-partum)