Pre-eclampsia Flashcards
(22 cards)
What should be measured at each antenatal appointment?
BP and urine for proteinuria
Use dipstick for initial testing, and if positive, quantify proteinuria with albumin:creatinine or protein:creatinine ratio.
What is the threshold for protein:creatinine ratio to indicate proteinuria?
30mg/mol
A threshold of 8mg/mol for albumin:creatinine ratio is also used.
What dosage of aspirin is recommended for women with high-risk factors during pregnancy?
75-150mg OD from 12 weeks gestation until delivery
This is for women with one high-risk or two moderate-risk factors.
List high-risk factors for pre-eclampsia.
- Hypertensive disease in a previous pregnancy
- Pre-existing maternal disease (chronic hypertension, renal disease, diabetes, autoimmune disease)
Examples of autoimmune diseases include SLE and antiphospholipid syndrome.
List moderate-risk factors for pre-eclampsia.
- First pregnancy (primigravid)
- Age >40 years
- Pregnancy interval of >10 years
- BMI >35 at booking visit
- Family history of pre-eclampsia
- Multiple pregnancy
When should more frequent BP measurements be considered?
For women with any high-risk or moderate-risk factors
This is recommended by NICE guidelines.
What are the indications for admission to the antenatal ward?
- Severe hypertension (BP >160/110 mmHg)
- Symptoms of severe late-stage disease (e.g., headache, visual disturbance)
- Biochemical abnormalities
- Haematological abnormalities
- Suspected fetal compromise
What is the aim for blood pressure management in pregnant women with pre-eclampsia?
BP <135/85 mmHg
What is the first-line antihypertensive for managing pre-eclampsia?
Labetalol
Second-line is nifedipine and third-line is methyldopa.
What is the definitive treatment for pre-eclampsia?
Delivery
At what gestational age should delivery be arranged for women with pre-eclampsia?
37 weeks’ gestation
Earlier delivery may be necessary under certain conditions.
What should be done if delivery occurs before 34 weeks?
IV magnesium sulfate + course of antenatal corticosteroids
What mode of delivery is offered for women with pre-eclampsia?
Choice between elective C-section or induction of labour
What is the recommended monitoring for blood pressure postnatally?
- At least 4x/day while inpatient
- Every 1-2 days for up to 2 weeks after discharge
What should be done if a woman was taking methyldopa during pregnancy after delivery?
Stop within 2 days after birth and change to an alternative agent if necessary
What is the risk of recurrence for pre-eclampsia in subsequent pregnancies?
~15%
What should be explained to a patient regarding the risks of pre-eclampsia?
- Early delivery
- Reduced placental function
- Intrauterine growth restriction (IUGR)
- Risks to the mother
What is the epidemiology of pre-eclampsia in pregnancies?
2-3% of pregnancies
What safety net advice should be given to patients not admitted for pre-eclampsia?
Attend hospital immediately if experiencing ongoing/severe headaches, visual changes, nausea/vomiting, epigastric pain, oliguria, seizures
True or False: There is a cure for pre-eclampsia other than delivery.
False
The only definitive treatment is the delivery of the baby and placenta.
If induction of labour is preferred, what measured should be taken for delivery?
- Advise to deliver in labour ward, with continuous CTG monitoring
- Analgesia (encourage use of epidural anaesthesia which helps control
BP) - Avoid use of ergometrine
Monitoring required for pre-eclampsia?
▪ BP at least every 2 days, and more frequently if woman is admitted to hospital
▪ Bloods (FBC, LFTs, U&Es) 2x/week
▪ US foetal surveillance (growth, liquor, UA blood flow) every 2 weeks
