Disorders of placentation

Question 1

Pre-eclampsia definition (5)

Answer 1

1. BP at least 140/90mmHg
2. 2 separate occassion 4 hours apart
3. Presence of at least 300mg protein in 24H urine protein
4. After 20th week gestation
5. Resolved 6 weeks post-partum

Note: albumin

1+(300mg)

2+(1g)

3+(3g)

Question 2

Risk factors of pre-eclampsia (8)

Answer 2

• Primigravida
• Previous history
• Advanced maternal age
• BMI > 35
• Family history
• Booking proteinuria (1+ ketone)
• Multiple pregnancy
• Medical condition

Question 3

Pre-eclampsia symptoms (8)

Answer 3

• Frontal headache
• Blurring vision
• Visual disturbance
• Epigastric pain
• Nausea vomiting
• Hypereflexia/clonus
• Pedal edema
• Lethargic

Question 4

Investigation of pre-eclampsia

Answer 4

Maternal

• FBC (platelets and hct)
• Renal profile (uric acid)
• Liver profile

Fetal

• Ultrasound (size, AFI, doppler)
• CTG

Question 5

Anti-hypertensive therapy in pregnancy

Answer 5

Oral/IV Labetalol (alpha & beta blocker) Oral Methyldopa (central acting). Long acting. Cause sedation and depression Oral Nifedipine (CCB). Cause headache IV hydralazine Eclampsia: IV Magnesium sulphate

Question 6

Management of pre-eclampsia (5)

Answer 6

1. IM dexamethasone <34 weeks
2. Delivery through cesarean section
3. Prophylactic SC Heparin
4. TED stocking
5. Avoid ergomentrine! (Increase BP)

Question 7

SGA causes (2)

Answer 7

1) FGR [Fetal] Congenital anomalies (renal agenesis) Fetal infection (TORCHES) Chromosomal abnormalities (trisomy) [Maternal] Medical condition (hypoxia) Malnutrition Smoking [Placenta] Single artery, TTTS, multiple gestation 2) Contitutional

Question 8

Risk factors of placenta abruptio (7)

Answer 8

Hypertension Smoking Abdomen trauma Cocaine Anticoagulant Polyhydramnion FGR Complications: Shock, DIVC, ARF, Fetal hemorrhage, FGR, Mortality