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Reproductive Medicine > Pregnancy complications - Pre-eclampsia and Eclampsia > Flashcards

Pregnancy complications - Pre-eclampsia and Eclampsia Flashcards

1
Q

What is pre-eclampsia?

A

A hypertensive syndrome that occurs in pregnant women after 20 weeks’ gestation, consisting of new-onset, persistent hypertension (defined as a BP of ≥140 mmHg systolic and/or ≥90 mmHg diastolic, based on at least 2 measurements taken at least 4 hours apart) with either proteinuria (defined as urinary excretion of ≥0.3 g protein/24 hours) or evidence of systemic involvement.

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2
Q

What is thought to be the main pathophysiological cause of pre-eclampsia?

A

Failure of trophoblastic invasion of spiral arteries, leaving them vasoactive. This leaves them unable to clamp down in response to vasoconstrictors, and this protects placental flow. The dysfunctional placenta releases pro-inflammatory mediators, which increase BP (hypertension) and make vessels more leaky (oedema). They also affect the kidneys (proteinuria) and even the liver

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3
Q

When does pre-eclampsia manifest?

A

>20 weeks gestation

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4
Q

How long after delivery does pre-eclampsia resolve?

A

Roughy 6 weeks

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5
Q

What are risk factors for pre-eclampsia?

A
  • Previous pre-eclampsia/Early onset
  • Chronic hypertension - current or previous pregnancy
  • CKD
  • DM
  • Autoimmune disease - SLE, antiphospholipid, thrombophilia
  • 1st pregnancy
  • >40 yrs
  • FH pre-eclampsia
  • Multiple pregnancy
  • Low PAPP-A
  • BMI >/= 30
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6
Q

What are complications fo pre-eclampsia?

A
  • Eclampsia
  • HELLP
  • Cerebral haemorrhage
  • IUGR
  • Renal Failure
  • Placental abruption
  • DIC
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7
Q

What cut off for blood pressure is used in defining pre-eclampsia?

A
  • SBP > 140
  • DBP > 90
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8
Q

What level of protein in the urine is used to define pre-eclampsia?

A

Urinary protein ≥0.3 g protein/24 hours

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9
Q

What are the physiological effects of pre-eclampsia?

A
  • Decreased plasma volume
  • Increased peripheral vascular resistance
  • Placental ischaemia
  • If BP > 180/140 - microaneurysms develop in arteries
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10
Q

What are symptoms of pre-eclampsia?

A

May be asymptomatic, or:

  • Headache
  • Flashing lights
  • Epigastric/RUQ pain
  • Nausea and vomiting
  • Swelling of face/fingers/lower limbs
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11
Q

What are signs of pre-eclampsia?

A
  • Tachycardia
  • Hypertension
  • Proteinura
  • Epigastric/RUQ tenderness
  • Reduced foetal movements
  • Hyperreflexia
  • >2 beats clonus
  • Confusion
  • Oliguria
  • Fits
  • Oedema
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12
Q

What investigations would you consider doing in someone with suspected pre-eclampsia?

A
  • Bedside - Dipstick, Basic observations, foetal CTG, consider fundoscopy
  • Bloods - FBC, LFTs, U+E’s, Coag screening
  • Imaging - Foetal USS, Umbilical artery doppler velocimetry
  • Other - Amniotic fluid assessment, consider MSSU
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13
Q

What might you see on urinalysis in pre-eclampsia?

A

Proteinuria

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14
Q

What might the preotin:creatinine ratio be in someone with Pre-eclampsia?

A

>30 mg/mmol

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15
Q

Why might you do foetal ultrasound in someone with pre-eclampsia?

A

Due to reduced foetal movements - always requires and ultrasound

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16
Q

What might you see on FBC in someone with pre-eclampsia?

A
  • Thrombocytopenia
  • Anaemia
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17
Q

What might you find on LFT in someone with pre-eclampsia?

A

May be elevated

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18
Q

What might you find on foetal CTG in someone with pre-eclampsia?

A

Signs of foetal distress

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19
Q

What might you find on investigation of coag screen in someone wtih pre-eclampsia?

A

May be normal, but PT or APTT may be prolonged in DIC

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20
Q

What might you find on foetal USS?

A
  • IUGR
  • Oligohydramnios
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21
Q

What might you find on doppler USS of umbilical arteries and uterus in someone with pre-eclampsia?

A
  • Notching of the uterine arteries
  • Abnormal umbilical artery
22
Q

What might anaemia, elevated LFTs and low Platelets indicate?

A

HELLP syndrome

23
Q

What bloods usually derange first in HELLP syndrome; Haemoglobin, LFTs or PLatelets?

A

LFTs elevate first

24
Q

What is eclampsia?

A

OBSTETRIC EMERGENCY

  • Tonic-clonic seizures + pre-eclampsia
25
Q

What are the main causes of death in pre-eclampsia/eclampsia?

A
  • Cerebral haemorrhage
  • HELLP
  • Organ failure
26
Q

What is regarded as mild pre-eclampsia?

A

BP - 140-149/90-99 mmHg

27
Q

What is regarded as moderate pre-eclampsia?

A

150-159/100-109 mmHg

28
Q

What is regarded as severe pre-eclampsia?

A

>160/110 mmHg, or signs/symptoms, or end organ damage

29
Q

How would you manage someone with mild pre-eclampsia?

A
  • 4-hourly BP
  • Twice weekly bloods
  • Foetal growth scans every 2 weeks
  • Induce after 37 weeks
  • Only use antihypertensives if >150/100 mmHg
30
Q

How would you manage someone with moderate pre-eclampsia?

A

Admit until delivery

  • 4-hourly BP
  • Check bloods 3 times/week
  • Fortnightlly foetal growth scans
  • Twice daily CTG
  • Start antihypertensives
31
Q

How would you manage severe pre-eclampsia?

A

Call for senior help, anaesthetics and midwife:

  • Stabilise BP - Oral, then IV if not working (Labetalol, hydralazine - small bolus
  • Prophylactic IV Magnesium sulphate
  • Bloods every 12-24 hours
  • Strict fluid balance + catheter
  • Steroids - if indicated i.e. preterm
  • Deliver baby
32
Q

What is the main cure for pre-eclampsia?

A

Delivery of the baby

33
Q

What IV drugs would you consider for controlling BP in pre-eclampsia?

A
  • Labetalol
  • Hydralazine
34
Q

What oral anti-hypertensives would you consider giving someone to control BP in pre-eclampsia?

A

Nifedipine

35
Q

When would you consider giving IV anti-hypertensives in pre-eclampsia?

A

If BP > 160/110 mmHg

36
Q

What would you use in subsequent pregnancies as a prophylactic for pre-eclampsia?

A

Low dose aspirin

37
Q

If you were giving prophylactic magnesium sulphate in severe pre-eclampsia, what dose would you give?

A

4g IV loading dose, then 1g/hr

38
Q

If someone developed eclampsia, how would you manage them?

A

Call for help:

  • ABCDE - IV access, bloods, catheterise
  • Magnesium sulphate
  • Consider diazepam in repeated seizures
  • Restrict fluids - <80ml/h
  • Monitor CTG
  • Deliver once mother is stable
39
Q

What dose of magnesium sulphate would you give for eclampsia, and at what rate?

A
  • 4g over 5-10 minutes, then 1g/h for 24 hrs.
  • Treat further fits with 2g bolus
40
Q

What methods of delivery are options for managing eclampsia?

A
  • IOL
  • LSCS - quicker
41
Q

What medication would you want to have handy in case of magnesium sulphate toxicity?

A

Calcium gluconate

42
Q

What fluid restriction would you put someone on if they were pre-eclamptic/eclamptic?

A

80mls/hr - only if no haemorrhage

43
Q

What are features of HELLP syndrome?

A

This is a syndrome indicative of moderate - severe PET - not a separate disease

  • Epigastric pain/RUQ pain
  • Nausea + vomiting
  • Dark urine
  • Hypertension
44
Q

How would you manage HELLP syndrome?

A

Same as for eclampsia - deliver baby

45
Q

If you chose to induce someone with pre-eclampsia, what drug should you not use to induce them?

A

Syntometrine

46
Q

Does smoking increase risk of PET?

A

No

47
Q

If someone presents with normal BP, bloods and examination, but has + protein on urinalysis, what might be the most likely cause?

A

UTI

48
Q

What are the main signs which indicate someone has severe pre-eclampsia?

A
  • SOB/cynosis
  • Oliguria
  • BP - 160/110
  • Proteinuria - +++
  • Neurological symptoms - clonus, hyperreflexia
49
Q

If someone required induction of labour/C-section for PET and the baby was preterm, what would you consider doing?

A

Steroid injection for foetal lung maturity

50
Q

If you admitted someone with PET, what thromboprophlactic measure would you take whilst trying to arrange management of the problem?

A

TED stockings

51
Q

Why might it be important to check MSSU in a patient with severe pre-eclampsia?

A

Before putting in catheter - check what organisms are there

52
Q

What is the risk of doing an epidural in a woman with severe pre-eclampsia?

A

Spinal haematoma

Reproductive Medicine (43 decks)

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