Pre Eclampsia

Question 1

What are the common signs of pre-eclampsia?

Answer 1

High blood pressure above 140/90
Visual disturbances
Epigastric pain
Oedema
Proteinuria

Question 2

Maternal complications of pre-eclampsia?

Answer 2

Intracranial haemorrhage
Placental abruption
Eclampsia
HELLP syndrome (characterised by haemolysis, elevated liver enzymes and low platelets)
DIC or disseminated intravascular coagulation
Renal failure
Pulmonary oedema
Acute respiratory distress syndrome

Question 3

Fetal complications of pre-eclampsia?

Answer 3

Fetal growth restriction
Oligohydramnios
Hypoxia from placental insufficiency
Placental abruption
Iatrogenic preterm birth

Question 4

Risk factors

Answer 4

Nulliparity
Pre-eclampsia during previous pregnancy
Hypertensive disease during previous pregnancy
Chronic hypertension
Family history of pre-eclampsia
Pre-existing diabetes
Multiple pregnancy
Obesity
Extremes of maternal age
Autoimmune disease
Renal disease
Interval of >10 years since previous pregnancy

Question 5

What are the first things you would do with a woman presenting with pre-eclampsia symptoms?

Answer 5

Urine sample
Blood pressure profile
CTG monitoring
Enquire about baby’s movements
Check bloods FBC, liver and kidney function tests

Question 6

What medications are used in maternity to treat hypertension?

Answer 6

Labetalol 200mg orally
Nifedipine capsule10mg orally NOT sublingually

Question 7

Which group of people are contraindicated for labetalol?

Answer 7

Persons of Afro Caribbean descent and those with asthma

Question 8

Contraindications for labetalol

Answer 8

Asthmatic and/or Afro-Caribbean

Question 9

What would be the first thing you do when a woman is having a suspected eclamptic fit?

Answer 9

Call for help and press emergency buzzer or call 999 if in community
Senior midwife, obstetrician and anaesthetist should attend
Note time seizure started and duration
Note time of emergency call and time of arrival of staff
Monitor and maintain airway, breathing and circulation as priority
Move mother to left lateral position and protect from injury
Give high flow oxygen via re-breath mask
Get eclampsia emergency box
Site x2 16 gauge grey venflons and take FBC, U&Es, LFTs, clotting, G&S.
Start magnesium sulphate treatment

Question 10

What is the loading dose of magnesium sulphate?

Answer 10

4g magnesium sulphate over 5 minutes

Question 11

How do you draw up the loading dose?

Answer 11

Draw up 8mL of 50% mag sulphate solution (4g) followed by 12 mL of 0.9% normal saline into a 20mL syringe = total of 20 mL.

Give manually as an IV bolus over 5 minutes (4mL/minute)

Question 12

What is the maintenance dose of magnesium sulphate?

Answer 12

1g/hour

Question 13

How do you draw up the maintenance dose?

Answer 13

Draw up 20mL of 50% mag sulphate solution (10g) followed by 30mL of 0.9% normal saline into a 50 mL syringe.
Place syringe in syringe driver and set pump to run at 5mL/hour.

Question 14

How long should the maintenance dose run for?

Answer 14

24 hours following birth or the last seizure or whichever is the most recent event.

Question 15

How would you monitor the woman with severe pre-eclampsia?

Answer 15

Montior vital signs: Resp rate, pulse, BP and oxygen saturation

Monitor urinary output: Catheterise with urometer and hourly urine measurement

Monitor proteniuria

Strict fluid balance: 1mL/kg/hour - total intake

Monitor mag sulphate toxemia

Monitor neurological status with reflex test

Montior fetus with CTG or intermittant ausculatation