Question 7: Preeclampsia

Question 1

1. What are the differential diagnoses?

Answer 1

Preg-induced HTN
Preeclampsia
Chronic HTN
White coat HTN

Question 2

2. What are the important features of the history and examination?

Answer 2

HX: headache/visual disturbances/RUQ or epigastric pain/oedema of the hands/face/feet particularly if sudden.

Hx of pregnancy so far, any complications

Risk fx: fam hx, obesity, prev HTN, diabetes

EXAMINATION:
repeat BP ensure correctly e.g. correct sized cuff, supported arm.

Check BMI. Fundal height. Look for oedema

Reflexes + clonus.

Urine dipstick: proteinuria

Question 3

What investigations do we do in PET?

Answer 3

Urine Protein creatinine ratio, MSU to exclude a UTI,
Bloods (FBC U&Es LFTS, preeclampsia sFLT-1/PIGF ratio for prognostic value)
USS - fetal wellbeing growth/liquor volume/doppler

We are looking to assess the severity of the PET and also if there is multi-organ involvement

Question 4

4. How will you continue to care for Jane and what will be the important steps in her management?

Answer 4

She has fatigue + swelling, pre-eclampsia
at 32 weeks, aim is to prolong pregnancy if there is no maternal or fetal compromise (e.g. renal or liver function deteriorating, HELLP, unable to control BP or fetal compromise e.g. faltering growth, distress). Regular monitoring is needed (RANZCOG says daily urine dipstick if no proteinuria, 2x weekly bloods if pre-eclampsia on bloods)

Steroids as <35 weeks
Mag sulphite can be used to prevent eclamptic fits