Pregnancy: Pre-eclampsia

Question 2

What is pre-eclampsia?

Answer 2

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

Question 3

What is the formal definition of pre-eclampsia?

Answer 3

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

Question 4

What are potential consequences of pre-eclampsia?

Answer 4

Eclampsia, neurological complications (altered mental status, blindness, stroke, clonus, severe headaches, persistent visual scotomata), fetal complications (intrauterine growth retardation, prematurity), liver involvement, haemorrhage, and cardiac failure.

Question 5

What are features of severe pre-eclampsia?

Answer 5

Hypertension typically > 160/110 mmHg, proteinuria (dipstick ++/+++), headache, visual disturbance, papilloedema, RUQ/epigastric pain, hyperreflexia, platelet count < 100 * 10^6/l, abnormal liver enzymes or HELLP syndrome.

Question 6

What are high risk factors for pre-eclampsia?

Answer 6

Hypertensive disease in a previous pregnancy, chronic kidney disease, autoimmune disease (e.g. systemic lupus erythematosus), type 1 or type 2 diabetes, chronic hypertension.

Question 7

What are moderate risk factors for pre-eclampsia?

Answer 7

First pregnancy, age 40 years or older, pregnancy interval of more than 10 years, BMI of 35 kg/m² or more at first visit, family history of pre-eclampsia, multiple pregnancy.

Question 8

How can the risk of hypertensive disorders in pregnancy be reduced?

Answer 8

Women with ≥ 1 high risk factors or ≥ 2 moderate factors should take aspirin 75-150mg daily from 12 weeks gestation until birth.

Question 9

What is the initial assessment for suspected pre-eclampsia?

Answer 9

NICE recommends arranging emergency secondary care assessment for any woman in whom pre-eclampsia is suspected. Women with blood pressure ≥ 160/110 mmHg are likely to be admitted and observed.

Question 10

What is the first-line management for pre-eclampsia?

Answer 10

Oral labetalol is now first-line following the 2010 NICE guidelines. Nifedipine and hydralazine may also be used.

Question 11

What is the most important management step for pre-eclampsia?

Answer 11

Delivery of the baby is the most important and definitive management step. The timing depends on the individual clinical scenario.

Question 12

Pre eclampsia - high and moderate risk factors

Answer 12