Pre-eclampsia and eclampsia Flashcards Preview

A1. Women's Health > Pre-eclampsia and eclampsia > Flashcards

Flashcards in Pre-eclampsia and eclampsia Deck (26):
1

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

2

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

3

At what BP must you start anti-hypertensive agents in a pregnant woman?

>170/110

4

Name 3 differentials for proteinuria in pregnancy

Normal (pregnancy induces proteinuria normally)
Contaminant (often from vaginal discharge released in pregnancy)
UTI
Pre-eclampsia

5

How is the distribution of oedema different in pre-eclampsia than normal pregnancy?

Facial oedema more prominent

6

What proportion of pregnancies in Australia will have mild and severe PE?

Mild - 5-10%
Severe - 1-2%

7

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

8

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

9

Name 5 risk factors for pre-eclampsia

FHx
Age extremes
First pregnancy
New paternity
Assisted reproduction
Sexual cohabitation (higher risk if woman is pregnant from first sexual activity with new partner)
Co-morbid disease

10

Name 3 medical conditions that predispose towards PE

Chronic HT (pregnancy-associated HT)
Renal disease
DM
Autoimmune diseases
Thrombophilias

11

Name 3 pregnancy conditions that predispose towards PE. How come?

Multiple pregnancy
GDM
Gestational trophoblastic disease
Hydrops fetalis
Trisomy 13

All increase placental mass (except Trisomy 13)

12

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

13

What are the 10 stages of management for severe pre-eclampsia (sorry....)

Admission
Stabilisation
BP control
Seizure prophylaxis
Fluid balance
Fetal welfare surveillance
Delivery
Third stage active management
Post-partum observation
Follow-up

14

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)

15

What usually occurs in the puerperium following severe pre-eclampsia?

Torrential diuresis to remove excess fluid

16

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
Labetalol
Nifedipine
Hydralazine
Diazoxide

17

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

18

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

19

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

20

Name 5 signs indicative of imminent eclampsia

Upper abdo pain, facial itchiness, visual disturbance, headache, rapidly increasing BP and proteinuria, increasing hyper-reflexia

21

What is the most common cause of seizures in pregnancy?

Epilepsy! Not eclampsia

22

Go through the 7 principles of management in eclampsia (sorry again...)

Protect patient
Protect airway
Control convulsion
Prevent further convulsions
Review maternal and foetal state
Stabilise maternal and foetal state
Deliver

23

What does the HELLP syndrome stand for? How does it relate to pre-eclampsia?

Haemolysis
Elevated Liver enzymes
Low Platelets

Subtype of pre-eclampsia where liver and blood are most affected

24

Name 3 Ddx for pre-eclampsia

Essential HT
Endocrine (Pheochromocytoma, Cushing's)
Renal HT

25

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

26

How does pre-eclampsia cause eclampsia?

Increased BP = cerebral oedema = cerebral dysfunction