Pre-eclampsia Flashcards
(26 cards)
What is pre-eclampsia?
Refers to new hypertension in pregnancy with end organ dysfunction, notably with proteinuria.
When does pre-eclampsia occur?
After 20 weeks gestation, when the spiral arteries of the placenta abnormally form, leading to high vascular resistance in these vessels.
What is the triad of pre-eclampsia?
Hypertension, Proteinuria, Oedema.
What is the difference between pregnancy induced hypertension & pre-eclampsia?
Pregnancy induced is hypertension after 20 weeks WITHOUT proteinuria. Pre-eclampsia is pregnancy induced hypertension associated with organ damage and proteinuria.
What is eclampsia?
When seizures occur as a result of pre-eclampsia.
What are some potential consequences of pre-eclampsia?
Eclampsia, fetal complications (intrauterine growth retardation, prematurity), liver involvement (elevated transaminases), haemorrhage (placental abruption, intra-abdominal, intra-cerebral), cardiac failure.
What is the pathophysiology of lacunae?
When the trophoblast implants in the endometrium, it sends signals to the spiral arteries in that area of the endometrium, which reduces vascular resistance there to make them more fragile so that when blood flows into those arteries, they break down leaving pools of blood called lacunae.
When do lacunae form and why?
Lacunae form at around 20 weeks gestation. Maternal blood flows from uterine arteries → lacunae → back out through uterine veins.
What is the pathophysiology of pre-eclampsia?
If the process of forming lacunae inadequate, the women can develop pre-eclampsia where there is high vascular resistance in the spiral arteries & poor perfusion of the placenta. This causes oxidative stress in the placenta, and the release of inflammatory chemicals into systemic circulation leading to systemic inflammation and impaired endothelial function in the blood vessels.
What are high risk factors for pre-eclampsia?
Pre-existing hypertension, Previous gestational hypertension, Existing autoimmune conditions, Diabetes, CKD.
What are moderate risk factors?
Older than 40, BMI > 35, More than 10 years since previous pregnancy, Multiple pregnancy, First pregnancy, Family history.
When are women offered prophylaxis and what are they offered?
Aspirin from 12 weeks gestation until birth if they have ONE high risk factor or MORE than one moderate risk factors.
What are symptoms of pre-eclampsia?
Headache, Visual disturbances or blurriness, Nausea & vomiting, Upper abdominal or epigastric pain, Oedema, Reduced urine output, Brisk reflexes.
How is diagnosis of pre-eclampsia made?
BP of >140/90 PLUS any of:
- proteinuria (+1 or more on urine dipstick)
- organ dysfunction (eg. raised CK, elevated liver enzymes, seizures, thrombocytopenia, haemolytic anaemia
- placental dysfunction (eg. fetal growth restriction or abnormal doppler studies)
How do you quantify proteinuria?
Urine protein:creatinine ratio- above 30mg/mmol is significant. Urine albumin:creatinine ratio- above 8mg/mmol is significant.
What else can you use to test on patients who you suspect may have pre-eclampsia?
Placental growth factor testing once per pregnancy, 20-35 weeks to rule out pre-eclampsia.
What is placental growth factor?
A protein released by the placenta that functions to stimulate the development of new blood vessels.
What specifically does NICE say about PIGF?
Use it between 20-35 weeks gestation to rule out pre-eclampsia.
How do you monitor women for pre-eclampsia?
All pregnant women are routinely monitored at every antenatal appointment for evidence of pre-eclampsia with:
- blood pressure
- symptoms
- urine dipstick for proteinuria
How do you treat gestational hypertension?
Aim to get blood pressure below 135/85 mmHg. Admission for women with a blood pressure above 160/110 mmHg. Urine dipstick testing weekly, Blood tests weekly, Monitoring fetal growth by serial growth scans, PIGF testing on one occasion.
How do you monitor/assess pre-eclampsia generally?
Scoring systems to determine whether to admit the woman (fullPIERS or PREP-S). Blood pressure monitored every 48 hours. Urine dipstick not routinely necessary after diagnosis. USS monitoring of fetus every 2 weeks.
How do you medically manage pre-eclampsia?
Labetalol - first line antihypertensive. Nifedipine - commonly used second line, or eg. if asthmatic. Methyldopa - third line but needs to be stopped within 2 days of birth.
What is used to treat pre-eclampsia in severe pre-eclampsia in critical care?
IV hydralazine.
What may be necessary for a woman with pre-eclampsia?
Planned early birth but corticosteroids should be given to women having a premature birth to help mature the fetal lungs.
