Pre-eclampsia

Question 1

How long is the human gestation period?

Answer 1

40 weeks

Question 2

When does the human gestation period counting start from?

Answer 2

The first day of the last menstraul period

Question 3

What is the role of the placenta?

Answer 3

Allos exchange of material between the foetus and the mother
Allows oxygen and nutrients in
Allows waste products and CO2 out
Seperates maternal and fetal circulations
Embeds into the decidual layer of the uterus

Question 4

What are the three different types of hypertension in pregnancy?

Answer 4

Chronic hypertension
Gestational hypertension
Pre-eclampsia

Question 5

What is chronic hypertension in pregnancy?

Answer 5

Hypertension before 20w gestation
Hypertension would have been present before pregnancy, is not caused by pregnancy.

Question 6

What is gestational hypertension in pregnancy?

Answer 6

Hypertension newly detected after 20w gestation without proteinuria
Absence of features of pre-eclampsia

Question 7

What is pre-eclampsia (PET)?

Answer 7

Hypertension after 20w gesation before 6 weeks post delivery with proteinuria
Can damage organs such as kidneys, brain and liver.

Question 8

What is the diagnostic criteria for pre-eclampsia?

Answer 8

Blood pressure above 140/90
Proteinuria

Or BP above 160/110 for severe with proteinuria

Or symptomatic presentations: maternal, organ dysfunction (renal or liver), neurological complications, haematological complications, uteroplacental dysfunction

Question 9

What are the risk factors for pre-eclampsia?

Answer 9

First pregnancy
Previosu history or family history
BMI>30
Multiple pregnancy
Maternal age >40yrs
Pregnancy interval >10yrs
Past medical history of diabets, renal disease, hypertension, PCOS
Autoimmune disease
Antiphospholipid antibody syndrome

Question 10

How does pre-eclampsia develop?

Answer 10

Abdnormal development of placenta vessels, particularly spiral arteries.
In healthy pregnancy will dilate to 5-10x their normal size to increase blood flow to fetus.
Pre-eclampsia: Are not as dilated as normal
Results in less blood flow through the placenta
This hypoperfused placenta releases pro-inflammatory cytokines which trigger endothelial cell dysfunction.
Causes systemic vasoconstriction and increased salt retention in the kidney.
Also areas of local vasospams

Question 11

How does pre-eclampsia effect the baby?

Answer 11

Lack of nutrients/ocygen in and lack of waste out
Can result in fetal growth restriction, pre-term delivery and even fetal death

Question 12

How does pre-eclampsia effect the mum?

Answer 12

Hypoperfused placenta released pro-inflammatory proteins which trugger endothelial cell dysfunction
results in systemic vasoconstriction and salt retention in the kidneys
Causes hypertension

Question 13

What are the four different categroies of effects of pre-eclampsia?

Answer 13

Glomerular damage
Retina
Liver swelling
Vascular permeability.

Question 14

How does pre-eclampsia effect the glomerulus?

Answer 14

Vasospams results in glomerular damage
Causes:
Oligouria (less urine)
Proteinuria

Question 15

How does pre-eclampsia affect the retina?

Answer 15

Vasospams results in blurred vision
Flashing lights
Scotoma (focal blurry spot)

Question 16

How does pre-eclampsia affect the liver?

Answer 16

Vasospams causes liver swelling
Elevated liver enzymes
Right upper quadrant/epigastric pain
Nausea and vomitting

Question 17

How does pre-eclampsia affect vascular permeability?

Answer 17

Vasospasm = Increase vascular permeability
Cause odema in the legs, hands and face
Pulmonary odema can cause shortness of breath and cough
Cerebral odema can cause headaches and seizures

Question 18

What are the immediate complications of pre-eclampsia?

Answer 18

Placental abruption - resulting in internal and external bleeding - risk of hemorrhage.
Eclampsia
HELLP Syndrome

Question 19

What is eclampsia?

Answer 19

When a person has pre-eclampsia and seizures
- new tonic-clonic seizures
- due to cerebral odema
- majority occur in post-natal period
-maternal mortality rate 1.8%, fetal mortality rate 30%

Question 20

What is HELLP syndrome?

Answer 20

Low Platelet - endothelial injury triggers thrombi formation which uses up platelets
Haemolysis - thrombus formation causes tubrulent blood flow destroying rbcs
Elevated Liver enzymes - vasospasm of vessels supplying liver cause liver swelling

Question 21

What investigations should you do for pre-eclampsia?

Answer 21

Frequent BP monitoring
Blood tests
Urine dipstick - for proetin-creatinine ratio
Ultrasound - fetal growth and wellbeing, uterine artery blood flow

Question 22

What blood tests should you order to investigate pre-eclampsia?

Answer 22

Full blood count
Urean and elctrolyes (kidney function particularly creatinine ratio)
Liver function tests
Uric acid (elevates in severe cases)

Question 23

What prevention can be given for women with a risk of pre-eclampsia?

Answer 23

Low dose aspirin from 12 weeks gestation till 36 weeks - given for women with two or more risk factors.
COX-1 inhibitor/anti-platelts - suppressed production of inflammatory proteins and inhibits aggregation of platelets
Reduces pre-eclampsia risk by 15%

Question 24

What predictive blood test can be given for pre-eclampsia?

Answer 24

sFlt-1 ; PlGF ratio
Used after 20 weeks in high risk women to predict risk of developing pre-eclampsia.
Predicts short term risk of developing pre-eclampsia in the next 7 days.
Higher indicates risk.

Question 25

How should you monitor for pre-eclampsia?

Answer 25

Patient education Frequent BP checks Weekly bloods Serial growth scans (2-4 weekly)

Question 26

What is the location of care for pre-eclampsia?

Answer 26

At home is mild and stable Admission if BP unstable, symptomatic or any signs or fetal compromise or complication

Question 27

What medication can be given for pre-eclampsia?

Answer 27

Antihypertensives: labetalol, nifedipine, methyldopa Seizure prevention: magnesium sulphate for severe PET or if symptomatic

Question 28

How is the derlivery of the baby adapted in pre-eclampsia?

Answer 28

May need to be delivered pre-term is any complications, not C-section is only used if vaginal birth is contraindicated. Most are delivery at 37 - labour is induced Mother takes priority over fetus

Question 29

What is the definitive treatment of pre-eclampsia?

Answer 29

Delivery of the placenta

Question 30

Can common hypertensives be used for pre-eclampsia?

Answer 30

No Ramipril and losartan potassium are contra-indicated

Question 31

How is eclampsia managed?

Answer 31

Obstetrics emergency call IV magnesium sulphate for prevention and treatment IV antihypertensive (labetalol or hydralazine) Continuous monitoring of mum and baby Prompt delivery of fetus (emergency C-section) once mum is stable.

Question 32

What are the long term complications of pre-eclampsia?

Answer 32

1 in 6 chance of developing pre-eclampsia in the future 5x rinc risk hypertension 3x in risk stroke 3x in risk major adverse cardiovascular event Slightly higher risk of end-stage kidney disease.

Question 33

What are the different term dates relating to delivery time? (pregnancy)

Answer 33

Term delivery - between 37 weeks and 41weeks+6 days Pre-term - delivery before 37 weeks

Question 34

What are some statistics that show the prevalence of hypertension in pregnancy?

Answer 34

Affects 8-10% of pregnancies Hypertensive disorders are one of the leading causes of direct maternal deaths in the UK.

Question 35

How does pregnancy normally affect the cardiovascular system? How does this relate to the presentation of chronic hypertension?

Answer 35

Early pregnancy - decreased SVR - normally causes hypotension in early pregnancy CO slowly increases, does not overcome decrease in SVR until 20 weeks - this is when hypertension that is pregnant induced may occur.

Question 36

What anti-hypertensive medications should be given to treat chronic hypertension and gestational hypertension in pregnancy?

Answer 36

Common anti-hypertensives such as ramipiral are contraindicated Should offer - labetalol hydrochloride (non-selective beta blocker) 2nd - nifedipine - Calcium channel blocker allosteriic 3rd - methyldopa - pro-drug alpha 2 agonist

Question 37

How common is pre-eclampsia?

Answer 37

Affects 1-5% of pregnant women

Question 38

What indicates significant proteinuria eligible for pre-eclampsia diagnosis?

Answer 38

Protein creatinine ratio over 30.

Question 39

What device can be used to monitor a fetus in the uterus?

Answer 39

A CTG machine - monitors heart rate. Two flat round sensors are placed on baby bump to monitor Can also detect uterine contractions

Question 40

What is the Birth Reflection services?

Answer 40

Offered by NHS trusts when a coplicated pregnancy to delivery occurs Can be traumatic as most women expect an easy pregnany and unable to process at time. Example: increased hospitalisation, baby admitted to a neonatal unit Mam can self-referall, allows to ask midwife or ob doctor questions about pregnancy/deliver, speak to neonatal care unit about baby, is psychological support needed an appointment with a therapist can be arranged.