Pre-eclampsia And Eclampsia Flashcards
(23 cards)
What is pre-eclampsia?
It is a multi-system disorder originating from the placenta.
It is characterised by proteinuria and hypertension.
What is thought to be the pathophysiology of pre-eclampsia?
Thought to be due to a problem with trophoblastic invasion of the spiral arteries leaving them vasoactive.
This means they are reactive to vasoconstrictors which then compromises placental blood flow.
A high blood pressure partially compensates for this.
It effects hepatic, renal and coagulation systems.
Develops after 20 weeks and resolves within 6 weeks of delivery.
How does pre-eclampsia cause maternal morbidity and mortality?
Multi-organ failure
Adult respiratory distress syndrome
Cerebral haemorrhage
Why does pre-eclampsia increase the chance of prematurity?
Iatrogenic
Delivery is the only cure
What are the high risk factors of pre-eclampsia?
Previous severe/early-onset (<20 weeks) pre-eclampsia
Chronic hypertension/hypertension in a previous pregnancy
Autoimmune disease e.g. SLE, antiphospholipid syndrome
CKD
Diabetes Mellitus
What are the moderate risk factors of pre-eclampsia?
First pregnancy Multiple pregnancy FH of pre-eclampsia Age 40+ BMI 30+ Pregnancy interval over 10 years Low PAPP-A Uterine artery notching on USS at 22-24 weeks
When should aspirin be taken to prevent pre-eclampsia?
If 1 high risk factor is present or 2 moderate risk factors
75-150mg of aspirin should be taken everyday PO from 12 weeks to delivery
What are the foetal risk factors of pre-eclampsia?
Hydatiform mole
Multiple pregnancy
Foetal hydrops
What are the effects of pre-eclampsia?
Decreased plasma volume Increased peripheral resistance Placental ischaemia Microaneurysms DIC Oedema HELLP syndrome Placental infarcts
What are the serious complications of pre-eclampsia?
Eclampsia HELLP syndrome Cerebral haemorrhage Placental abruption IUGR Renal failure
What are the symptoms of pre-eclampsia?
May be asymptomatic if mild Headaches Flashing lights Epigastric/RUQ pain NV Swelling of the face/fingers/lower limbs
What are the signs of pre-eclampsia?
Hypertension (pregnancy-induced) Proteinuria RUQ/epigastric tenderness Brisk reflexes Clonus (over 2 beats) Confusion Fits IUGR Stillbirth Placental abruption
What are the investigations for pre-eclampsia?
Urine dipstick for proteinuria and then a 24 hour collection to quantify it
FBC - low platelets, low Hb (if haemolysis)
U&Es - high urea, creatinine and urate, low urine output - increased PCR
LFTs - raised transaminases
Prolonged PT and APTT
Foetal growth restriction and oligohydramnios on USS
Uterine artery notching/abnormality on doppler
What is mild pre-eclampsia and what is the treatment for it?
140-149/90-99 BP 4 hourly BP 2 weekly bloods - U&Es, LFTs, FBC 2 weekly growth scans IOL at over 37 weeks Don’t give antihypertensives until over 150/100
What is moderate pre-eclampsia and what is the treatment for it?
BP 150-159/100-109 Admit to hospital for monitoring until delivery if clinical concerns 4 hourly BP Bloods (FBC, LFTs, U&Es) 3 times a week Twice daily CTG Antihypertensives - aim 135/85 Foetal growth scans twice a week IOL at 37 weeks
What is severe pre-eclampsia and how is it managed?
BP > 160/110, symptoms/signs e.g. Clonus, end-organ damage
Get senior obstetrician
Control BP with hypertensives e.g. nifedipine PO
If this doesnt work, IV hypertensives e.g. labetalol, hydralazine
Strict fluid balance and catheterise
Bloods every 12-24 hours
Magnesium sulphate prophylaxis 4g loading dose and then 1g IV/hour
Steroids for foetal lung maturity
Deliver if over 34 weeks
If under - timing decided by senior obstetrician, but usually once woman is stable
What is eclampsia?
It is an obstetric emergency characterised by pre-eclampsia + tonic-clonic seizure
- can have the seizure during the antenatal, intrapartum or postpartum period
It occurs in 1% of pregnancies with pre-eclampsia
What is the cause of death in eclampsia?
Cerebral haemorrhage
HELLP syndrome
Organ failure
What is the management for eclampsia?
ABCDE Call senior help Catheterise and fluid restrict - monitor urine output hourly Magnesium sulphate If repeated seizures give diazepam Keep calcium gluconate ready for magnesium sulphate overdose and respiratory depression Continuous CTG monitoring Deliver when stable
What is HELLP syndrome?
Elevated liver enzymes are the first sign and then low platelets and then haemolysis
A severe variant of pre-eclampsia
Cure is with delivery of the foetus
What are the symptoms of HELLP syndrome?
Raised BP
RUQ/epigastric pain and tenderness
NV
Dark urine due to haemolysis
What is the treatment for HELLP syndrome?
Same as eclampsia
Delivery is the definitive diagnosis
Regional anaesthesia is contraindicated if platelets under 80
If platelets under 50 and surgery required - cover with platelet transfusion
Why should syntometrine/ergometrine not be used in the 3rd stage of labour with eclampsia?
Can cause intracranial haemorrhage with severe hypertension leading to a stroke
Just use oxytocin
