Pre-eclampsia and eclampsia

Question 1

Defintions of pre-eclampsia, HELPP eclampsia and Hypertension in pregnancy

Answer 1

Hypertension- 140/90
Severe HTN- 160/110
Chronic HTN- HTN 1st present before 20W
Gestational HTN- HTN 1st presenting after 20W with no proteinura

Pre-eclampsia=
New HTN (after 20w), BP >140/90 with 1 of:
Proteinrura
any materal organ dysfunction (renal, liver, neuro, heam, utero)

HELPP- Heamolysis, elevated liver enzyme and low platelet- severe pre-eclampsia

Eclampsia- Pre-eclampsia + seizures

BP usually falls in the first half of pregnancy before rising back to pre-pregnancy levels before term

Question 2

RF and preventative Mx of pre-eclampsia and eclampsia

Answer 2

HIGH risk factors-
pre-eclampsia before
CKD, AID, diabetes, Chronic HTN
if >1 give aspirin

Moderate RF- primigravid, age>40, preg interval >10y, BMI >35, Fhx, Multiple preg
>2 = aspirin

Question 3

Sx and ix of pre-eclampsia and eclampsia

Answer 3

BP usually falls in the first half of pregnancy before rising back to pre-pregnancy levels before term

Pre-eclampsia in main asymptomatic- danger’
Severe headache, visual disturbances (flashing lights), Epigastric/RUQ pain, Vomiting, SOB, Sudden swelling of face, feet, hands

eclapmsia- those and seizures

Ix- Urine dipstick -if 1+ or more- PCR quantification
NO 24hr urine collection

Question 4

Mx of pre-eclampsia and eclampsia

Answer 4

High risk, chronic HTN- aspirin 75mg - no ace/arb- teratogenic

Pre-eclampsia-
1st line labetalol (no in asthma)
2nd- nifedipine
3rd methydopa

Eclpamis- Mg sulphate - cerebral vasodilator

Question 5

Mx of disovered gestational HTN

Answer 5

Gestational - 1st present after 20w–
admission if >135/85
1st line labetalol, then nifedipine, methydopa

BP measure 1 -2 x a week
dipstick 1-2x a week
FBC/LFT and renal at presentation

antepartum- Test on repeat assessment-every 2-4weeks - USS for foetal growth, amniotic fluid assess, artery doppler
Dipstick, BP
if chornic - assess at 28, 32, 36w

If HTN > 140 with medication
after admitted if HTN >160
FBC/LFT renal 1x per week

deliver at 37w gestation

Question 6

MX upon disovering pre-eclampsia/severe HTN

Answer 6

admission if over 160 -target 135
labetalol -> nifedipine -> methydopa

Moderate pre-eclampsia--
BP measure every 48h if not admitted
4x a day if admitted
Bloods 2x a week
admission CTG, USS, doppler etc

severe –
every 15-30mins until BP under 160
FBC 3x a week, same admission BT

after discharge– repeat USS/dopller, amniotic, dipstick, BP every 2 weeks
BT 2x a week if not admitted
BT 3x a week if admitted

brith
if at 34w- antenatal steoids, MgSO4
brith 34-37w- surveullance
>37w- induce withing 24/48h

Question 7

Intrapartum care for pre-eclampsia

Answer 7

continuous CTG, BP monitor and continue antihypertensive
if under 160 - every 4h BP
if over 160- every 15mins
Epidural help reduce BP

consider anticonvulstants if previous fits, birth planned in next 24h, foetures of severe -preeclampsia prevsent
give IV MgSO4 (reverse with calcium glucoronate)
antihypertensives- IV labetalol
steroids if <34w and birth in next 7 days

Avoid ergometrine

Question 8

Postnatal care for pre-eclampsia

Answer 8

Dsicahrge criteria-
no sx of pre-eclampsia
BP under 150
BT stable or imrpooving

monitor bp 4x a day inpatient, every other day if outpatient
until achieved- 1 per week
wean HTN

follow up plan to have for frequency, threshholds, safegauarding

Breastfeed- avoid dirutetic,
no ARB/ACE/Amlodipine
safe-labetalol, nifedipine,

Question 9

Aetiology of pre-eclampsia

Answer 9

Impaired throphoblastic invasion of spiral arteries-
impaired invasion -> high resistance
Low flow-poor perfusion
Placenta release factors -> promote systemic effects

Oedema, proteinura, endoethelial damage (platelet use), elevated liver enzymes (HELPP)
vasospasn, cerebral oedema -> eclampsia