Pre-eclampsia

Question 1

what is it?

Answer 1

new-onset hypertension
proteinuria
oedema

Question 2

defined by what BP

Answer 2

new-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy, AND 1 or more of the following:
proteinuria
other organ involvement (see list below for examples): e.g. renal insufficiency (creatinine ≥ 90 umol/L), liver, neurological, haematological, uteroplacental dysfunction

Question 3

features

Answer 3

eclampsia

other neurological complications include altered mental status, blindness, stroke, clonus, severe headaches or persistent visual scotomata

fetal complications

intrauterine growth retardation

prematurity

liver involvement (elevated transaminases)

haemorrhage: placental abruption, intra-abdominal, intra-cerebral
cardiac failure

Question 4

features of severe pre-eclampsia

Answer 4

hypertension: typically > 160/110 mmHg and proteinuria as above

proteinuria: dipstick ++/+++

headache

visual disturbance

papilloedema

RUQ/epigastric pain

hyperreflexia

platelet count < 100 * 106/l, abnormal liver
enzymes or HELLP syndrome

Question 5

high risk factors

Answer 5

hypertensive disease in a previous pregnancy

chronic kidney disease

autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome

type 1 or type 2 diabetes

chronic hypertension

Question 6

moderate risk factors

Answer 6

first pregnancy

age 40 years or older

pregnancy interval of more than 10 years

body mass index (BMI) of 35 kg/m² or more at first visit

family history of pre-eclampsia

multiple pregnancy

Question 7

prevention

Answer 7

women high risk should take aspirin 75-150mg daily from 12 weeks gestation until the birth

Question 8

Mx

Answer 8

emergency hospital assessment

admission if bp 160/110 over

Question 9

medical mx

Answer 9

labetalol is now first-line following the 2010 NICE guidelines. Nifedipine (e.g. if asthmatic) and hydralazine may also be used