pre-eclampsia

Question 1

what are the risk factors for pre-eclampsia?

Answer 1

• maternal age > 40 years
• maternal BMI > 30
• family history
• parity (more likely in first pregnancy)
• multiple pregnancy
• previous PE
• birth interval > 10 years
• molar pregnancy/triploidy
• multiparous women develop more severe disease
• pre-existing conditions i.e. renal disease, hypertension, DM, CTD, thrombophilias

Question 2

describe the pathophysiology of pre-eclampsia?

Answer 2

• diffuse vascular endothelial dysfunction w widespread circulatory disturbance
• classified as early or late
  early: <34 weeks, uncommon, assoc w placental dysfunction
  late: >34 weeks, accounts for 9/10 cases
  stage 1: abnormal placental perfusion (placental ischaemia)
  stage 2: maternal syndrome (anti-angiogenic state assoc w endothelial dysfunction)

Question 3

what kind of liver disease can predispose a women to pre-eclampsia?

Answer 3

• HELLP syndrome
  : haemolysis, elevated liver enzymes, low platelets

> abnormal liver enzymes
hepatic capsule rupture

Question 4

how does placental disease affect baby?

Answer 4

• fetal growth restriction
• placental abruption
• intrauterine death

Question 5

what is the clinical presentation of pre-eclampsia

Answer 5

• hypertension
• proteinuria
• oedema
  > however women may be asymptomatic at the time of their first presentation

Question 6

what are some symptoms of pre-eclampsia?

Answer 6

• headache
• visual disturbance
• epigastric/RUQ pain
• nausea and vomiting
• rapidly progressive oedema

Question 7

what are some signs of pre-eclampsia?

Answer 7

• hypertension
• proteinuria
• oedema
• abdominal tenderness
• disorientation
• hyper-reflexia/involuntary movements/clonus
• SGA fetus
• intra-uterine fetal death

Question 8

what investigations are carried out for pre-eclampsia?

Answer 8

bloods: U+Es, serum urate, LFTs, FBC, coag screen
urine: protein:creatinine ratio
CTG
US - fetal assessment

Question 9

what is the mx for pre-eclampsia?

Answer 9

• low dose aspirin 150mg - may more beneficial in preventing severe early onset pre-eclampsia
  > used for high risk women
  > safe in pregnancy
  > commence before 16 weeks
• only ‘cure’ for pre-eclampsia is birth
  mother must be stabilised before birth
  consider expectant mx if pre-term
  steroids/magnesium sulphate
  most women delivered within 2 weeks of dx

Question 10

what are complications of pre-eclampsia?

Answer 10

• eclampsia
• HELLP syndrome - haemolysis, elevated liver enzymes and low platelets
• pulmonary oedema
• placental eruption
• cerebral haemorrhage
• cortical blindness
• disseminated intravascular coagulation (DIC)
• acute renal failure
• hepatic rupture