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E4 - Reproductive Health (S) > Pre-Eclampsia/Eclampsia > Flashcards

Pre-Eclampsia/Eclampsia Flashcards

1
Q

Define pre-eclampsia

A

A condition in pregnancy characterized by high blood pressure, sometimes with fluid retention and proteinuria

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2
Q

Outline the pathophysiology of pre-eclampsia

A

Normal = trophoblast invade myometrium + spiral A of uterus, destroying tunica muscularis media = spiral A dilated unable to constrict

PE = remodelling of spiral A is incomplete, high resistance, low placental blood flow, low BP + hypoxia/oxidative stress leads to inflam

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3
Q

List the risk factors for pre-eclampsia

A

Chronic HTN, pre-eclampsia or eclampsia in previous preg

Pre-existing CKD

Autoimmune disease - (SLE, antiphospholipid syndrome)

DM

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4
Q

How is pre-eclampsia diagnosed?

A

HTN (systolic BP >140 mmHg or diastolic BP >90 mmHg), on two occasions at least 4 h apart

Significant proteinuria – >30 mg/mmol urinary protein:creatinine

> 20 weeks gestation

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5
Q

What are the possible symptoms of pre-eclampsia?

A

Asymptomatic

Headaches (usually frontal).

Visual disturbances e.g. blurred or double vision, halos, flashing lights.

Epigastric pain (due to hepatic capsule distension/infarction).

Sudden onset non-dependent oedema.

Hyper-reflexia.

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6
Q

How is pre-eclampsia classified?

A

Mild = 140/90-149/99

Moderate = 150/100 – 159/109

Severe = > 160/110 + proteinuria > 0.5 g/ day
or > 140/90 mmHg + proteinuria + symptoms

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7
Q

What are the complications of pre-eclampsia?

A

Hepatic

  • HELLP syndrome – haemolysis, elevated liver enzymes, low platelets
  • Liver rupture

Neurological

  • Eclampsia
  • Cerebrovascular haemorrhage (1-2%)
  • Venous sinus thrombosis
  • Cerebral oedema

Resp

  • Pulmonary embolus
  • Pulmonary oedema

Cardiac

  • Cardiomyopathy
  • IHD
  • Chronic HTN (4-fold ↑ risk post-partum).

Renal

  • AKI
  • Worsening CDK

Haematological

  • Haemolysis
  • Thrombocytopenia
  • Haemorrhage (APH and PPH)
  • Thromboembolism

Fetus/placenta

  • Abruption
  • Growth restriction
  • Stillbirth
  • Prem complications
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8
Q

What are the fetal complications of pre-eclampsia?

A

Prematurity

Intrauterine growth restriction

Placental abruption

Intrauterine fetal death

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9
Q

How should pre-eclampsia be Ix?

A

BP

Protein:creatinine ratio

FBC = ↓ Hb, ↓ plat

U+E = ↑ urea, ↑ creatinine, ↑ urate, ↓ urine output

LFT = ↑ ALT, ↑ AST

G+S if planning delivery

USS - growth, liquor vol, umbilical A doppler

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10
Q

Outline the management of pre-eclampsia

A

Regular BP, urinalysis, blood tests, fetal growth scans and cardiotocography

Control HTN = labetalol (a/b-blocker), nifedipine (CCB), methyldopa (a2-agonist), hydralazine (vasodilator, when labetalol not effective)

VTE prevention - LMWH

Delivery - only definitive cure
- <34w need caesarean

Corticosteroids - <34w for lung maturation

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11
Q

Define eclampsia

A

Occurrence of one or more convulsions in a pre-eclamptic woman in the absence of any other neurological or metabolic causes

It is an obstetric emergency

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12
Q

What are the clinical features of eclampsia?

A

New onset tonic-clonic seizures in the presence of pre-eclampsia

Seizures = 60-75s, post-ictal phase

Symptoms of pre-eclampsia

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13
Q

How is eclampsia managed?

A

1 = resuscitation, A-E, lie in L lateral with secured airway and O2

2 = seizures treated with magnesium sulphate

3 = BP control with IV labetalol, continuous CTG

4 = prompt delivery, CS ideal

5 = fluid restrict (85ml/h), foley catheter

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14
Q

What is gestation HTN or pregnancy-induced HTN (PIH)?

A

New-one HTN without proteinuria after >20w

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15
Q

What are the important questions to ask when suspecting pre/eclampsia?

A

Gestation

S+S = headache, visual disturbance, epigastric pain, oedema, unwell

Fetal movements

Recent scan results

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16
Q

Outline what needs to be examined when suspecting pre/eclampsia

A

BP (manual) + full obs

Urine dip - proteinuria

Neuro

Fundoscopy - papilloedema

Abdo

Uterine palpation/fundal height

Examine for oedema

Reflexes - hyper-reflexes and clonus (seizure predictor)

Auscultate fetal heart or CTG if >28w

17
Q

What is HELLP?

A

Haemolysis, elevated liver enzymes and low platelets

Variant of severe pre-eclampsia
Plt <100
Haemolysis not always present

Mx = stabilise haematological problems then deliver

18
Q

What are the indications for delivery?

A 
Uncontrolled HTN
Eclampsia
HELLP
Impending eclampsia or liver rupture
Deranged bloods - renal failure, hypoNa
Fetal concerns
19
Q

How can we reduce the risk of pre/eclampsia?

A

Aspirin 75-150mg daily to women with 2 moderate risk factors (from 12w until birth)

E4 - Reproductive Health (S) (40 decks)

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