Flashcards in Pre-eclampsia and eclampsia Deck (26)
What is the difference between pregnancy-associated hypertension and pregnancy-induced hypertension? What is another name for pregnancy-induced hypertension?
Pregnancy-associated HT = HT that exists before and will exist after pregnancy
Pregnancy-induced HT (pre-eclampsia) = HT caused by pregnancy that will resolve after pregnancy
What is the definition of pre-eclampsia (including values)?
Pregnancy induced hypertension (>140/90 or >30/15 above baseline), proteinuria (300mg/24 hrs), generalised oedema, and multi-system dysfunction
At what BP must you start anti-hypertensive agents in a pregnant woman?
Name 3 differentials for proteinuria in pregnancy
Normal (pregnancy induces proteinuria normally)
Contaminant (often from vaginal discharge released in pregnancy)
How is the distribution of oedema different in pre-eclampsia than normal pregnancy?
Facial oedema more prominent
What proportion of pregnancies in Australia will have mild and severe PE?
Mild - 5-10%
Severe - 1-2%
What 6 organ systems are affected in PE and how?
Cardiovascular - HT, pulmonary oedema
Renal - oligouria, renal failure
Haematological - haemolysis, thrombocytopaenia, DIC
Neurological - eclampsia, cerebral oedema and haemorrhage
Hepatic - cellular dysfunction, rupture
Uteroplacental - abruption, IUGR, FDIU
What are the 3 stages of pre-eclampsia? Outline the general management of each stage
Stage 1 - just HT. No need for admission, aim for delivery at term
Stage 2 - HT + proteinuria. Admit today for delivery 34-36 weeks
Stage 3 - HT + proteinuria + symptoms of end-organ dysfunction. Admit immediately for anticonvulsants and delivery after stabilisation
Name 5 risk factors for pre-eclampsia
Sexual cohabitation (higher risk if woman is pregnant from first sexual activity with new partner)
Name 3 medical conditions that predispose towards PE
Chronic HT (pregnancy-associated HT)
Name 3 pregnancy conditions that predispose towards PE. How come?
Gestational trophoblastic disease
All increase placental mass (except Trisomy 13)
Name 5 indicators suggestive of severe PE (think of the systems affected)
Cardio - Extreme HT (refractory to anti-HTs), pul oedema
Neuro - Headache, papilloedema, seizures, hyperreflexia, visual disturbances
Renal - oliguria, generalised oedema, worsening proteinuria
Haematological - thrombocytopaenia
Liver - elevated enzymes, upper abdo pain
What are the 10 stages of management for severe pre-eclampsia (sorry....)
Fetal welfare surveillance
Third stage active management
What is the key treatment principle of severe pre-eclampsia? Why do they say this?
PE is cured by delivery, but not at delivery! Things can still go wrong after delivery (15-30% of eclampsia is postpartum)
What usually occurs in the puerperium following severe pre-eclampsia?
Torrential diuresis to remove excess fluid
Name 3 anti-HT agents used in PE. Which one can't be used for rapid BP reduction?
Methyldopa - only oral and slow acting, not good for acute setting
Are anti-HTs disease-modifying agents in PE? If not, why do we use them?
Not disease-modifying, but they reduce the risk of stroke
What medication do you give for neuronal stabilisation? Name 3 things to monitor for after giving this medication. What is the antidote to this medication?
MgSO4 IV. Monitor serum levels, reflexes (avoid areflexia!), respiration and urine output.
Give CaCl2 as antidote
Name 5 factors that would help you determine whether to deliver vaginally or by C/S in pre-eclampsia
Vaginally - multiparous, stable BP and CNS, ripe cervix, mature foetus (> 1.5kg estimated weight), cephalic, good foetal surveillance
C/S - primip, unstable BP, cerebral irritability, unripe cervix, immature foetus, breech, abnormal foetal doppler or CTG
Name 5 signs indicative of imminent eclampsia
Upper abdo pain, facial itchiness, visual disturbance, headache, rapidly increasing BP and proteinuria, increasing hyper-reflexia
What is the most common cause of seizures in pregnancy?
Epilepsy! Not eclampsia
Go through the 7 principles of management in eclampsia (sorry again...)
Prevent further convulsions
Review maternal and foetal state
Stabilise maternal and foetal state
What does the HELLP syndrome stand for? How does it relate to pre-eclampsia?
Elevated Liver enzymes
Subtype of pre-eclampsia where liver and blood are most affected
Name 3 Ddx for pre-eclampsia
Endocrine (Pheochromocytoma, Cushing's)
What is the main theory for why pre-eclampsia occurs?
Poor implantation of the placenta = reduced oxygenation of foetus in later pregnancy = release of vasoactive factors by placenta into maternal circulation to increase blood supply = systemic vasoconstriction = increased BP