4: Pre-eclampsia

Question 1

Gestational hypertension is a BP > __/__ on ___ recordings ___ apart after ___ weeks gestation

Answer 1

Gestational hypertension is a BP > 140/90 on 2 recordings 4 hours apart after 20 weeks gestation

Question 2

What are the organ systems involved in pre-eclampsia?

Answer 2

CVS/Haem: Plt <100, haemolysis or DIC
RS: pulmonary oedema
Gastro: elevated LFTs, severe epigastric/RUQ pain
Neuro: eclampsia (seizures), hyper-reflexia with sustained clonus, headache or persistent visual disturbance, stroke
Foetal: growth restriction

Question 3

___% of pre-eclampsia occurs at term

Answer 3

60

Question 4

Risk factors for gest. hypertension and pre-eclampsia

Answer 4

Genetic: maternal age, ethnicity
Current pregnancy: multiple pregnancy
Obs hx: previous PET, nulliparity, prev SGA
General medical: autoimmune disease, renal disease, chronic HTN, diabetes
FHx: PET or HTN

Question 5

Pathophysiology of PET

Defective invasion of spiral arteries -> __ resistance -> placental ___ and reduced ___ -> vasoactive mediators

1.
2.
3.

Answer 5

Pathophysiology of PET

Defective invasion of spiral arteries -> inc. resistance -> placental ischaemia and reduced perfusion -> vasoactive mediators

1. Hypertension
2. Vasoconstriction
3. Capillary leakage

Question 6

Maternal cx of PET

Answer 6

Renal: proteinuria, acute renal failure
Haem: coagulopathy, haemolysis
GI: hepatic dysfunction, rupture
Neuro: eclampsia, stroke
Vasc: pul oedema, peripheral oedema

Question 7

Foetal cx of PET

Answer 7

• Pre term birth
• SGA or IUGR
• Acute foetal distress
• Inc. perinatal mortality
• Long term: cerebral palsy, chronic lung disease, deafness, blindness

Question 8

What is the most common body system involved with PET?

Answer 8

Renal (GUS)

Question 9

Investigations for PET

Answer 9

Lab

• Urine: dipstick, MSU
• Bloods: FBC, U&E, creatinine, LFT, coags, group and screen

Imaging

• USS (with doppler at 20 week scan if high risk)
• CTG

Question 10

What is the threshold for treating hypertension in pregnancy? What do you tx with?

Answer 10

140/90

Methyldopa, labetalol, nifedipine

Question 11

Who receives MgSO4 for PET?

Answer 11

Women who have had or are at risk of eclamptic seizure e.g. severe HTN, symptoms, brisk reflexes, >2 beats clonus

Question 12

PET prophylaxis?

Answer 12

100mg aspirin starting at 12-16 weeks

Ca 1000mg/day

Question 13

What is HELLP syndrome?

What is eclampsia?

Answer 13

HELLP = haemolysis, elevated liver enzymes, low platelets

Eclampsia = new onset seizures in association with pre-eclampsia