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Reproductive Health > Pre-eclampsia, eclampsia, HELLP syndrome > Flashcards

Pre-eclampsia, eclampsia, HELLP syndrome Flashcards

(49 cards)

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1
Q

What is pre-eclampsia

A

Pregnancy induced HPTN with e nd organ dysfunction - proteinuria

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2
Q

What is pregnancy induced HPTN or gestational HPTN

A

HPTN occuring after 20 weeks gestation

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3
Q

What is eclampsia

A

Seizures occur as a result of pre-eclampsia

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4
Q

Why does pre-eclampsia happen after 20 weeks

A

When spiral arteries of placenta form abnormally -> high vascualr resistnace

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5
Q

What is the triad of pre-eclampsua?

A

HPTN
Proteinuria
Oedema

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6
Q

What can pre-eclampsia lead to?

A

Maternal organ dmaage
Foetal growth restriction
Seizures
Early labour
Death

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7
Q

What forms chorionic villi?

A

Syncytiotrophoblast, the outermost layer of the blastocyst -> finger like projections into endometrium = chorionic villi

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8
Q

What contatin feotal blood vessles

A

Chorionic villi

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9
Q

What makes spiral arteries more fragile

A

Trophoblast invasion of the endometrium send signals - reduces vascular resistance of sprial arteries

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10
Q

When do lacunae form

A

20 weeks gestation

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11
Q

How are lacunae formed

A

Trophoblast signals vascular resistance spiral arteries to decrease, blood flow to them increases and they break down leaving pools of blood - lacunae. Maternal blood -> uterine arteries -> lacunae -> uterine veins

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12
Q

What causes pre-eclampsia

A

High vascular resistance in spiral arteries and poor perfusion of placenta -> oxidatice stress in placenta ->inflam chemicals -> systemic infalmmation and impaired endothelial function in blood vessels

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13
Q

High risk factors for pre-eclampsia

A

Pre-existing HPTN
Prev HPTN in pregnancy
Existing AI conditions (SLE)
Diabetes
CKD

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14
Q

Moderate risk factors

A

> 40
BMI >35
10 years since prev pregnancy
Multiple pregnancy
First pregnancy
FH of pre-eclampsia

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15
Q

When are women offered aspirin from 12 weeks gestation until birth

A

One high risk factor
More than one moderate risk factors

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16
Q

Symptoms of pre-eclampsia

A

Headache
Visual disturbance
Nausea and vomitting
Upper abdominal or epigastric pain - due to liver swelling
Oedema
Reduced urine output
Brisk reflexes

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17
Q

What is the level for diagnosis of pre-eclampsia

A

Systolic >140 mmHg
Diastolic >90 mmHg
PLUS any of
-Proteinuris
-Organ dysfunction
-Palcental dysfunction

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18
Q

Signs of organ dysfunction

A

Raised creatinine
Elevated liver enzymes
Seizures
Thrombocytopenia
Haemolytic anaemia

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19
Q

Placental dysfunction ifentification

A

Foetal grwoth restriciton
Abnormal doppler studies

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20
Q

Urine protein:creatinine ratio level

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A

> 30mg/mmol significant

21
Q

Urine albumin:creatinine ration level

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A

> 8mg/mmol significant

22
Q

Proteinuria level on urine dipstick that counts for pre-eclampsia

Study These Flashcards
A

+1 or more on urine dipstick

23
Q

What is placental growth factor

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A

Protein released by placents stimulating development of new blood vessels
Low in pre-eclampsua

24
Q

WHat does NICE recommend about testing placental growth factor

Study These Flashcards
A

Test once between 20 and 35 weeks gestation to rule out pre-eclampsia if suspected

25
What is used for prophylaxis against pre-eclampsia
Aspirin
26
What is monitored at every antenatal appointment for evidence of pre-eclampsia
BP Symptoms Urine dipstick for proteinuria
27
When admit a pregnant woman with high BP
>160/110mmHg
28
What is the aim for treating HPTN in pregnancy
to get to 135/85 mmHg
29
How to monitor gestational HPTN without proetinuria
Urine dipstick testing at least weekly Monitoring of blood tests weekly - FBC, liver enzymes, renal profile Monitoring foetal growth by serial growth scans PIGF testing on one occasion
30
What scoring systems arae used to determine whether to admit the woman
fullPIERS PREP-S
31
What extra things are done when pre-eclampsia diagnosed vs gestational HPTN
fullPIERS or PREP-S BP monitored 48 hourly US monitor of foetus, amniotic fluid and dopplers 2 weekly No need for urine dips
32
Medical management pre-eclampsia options
Labetolol Nifedipine Methyldopa
33
Medical management in sec pre or eclmapsia
IV hydralazine IV mg sulphate Fluid restriction - avoid fluid overload
34
What is first line for pre-eclampsia
Labetolol
35
After first line meds for pre-eclampsia
Nifedipine - second line Methyldopa - 3rd line
36
What drug needs to be stopped within two dyas of birth
methyldopa
37
What drug is used as an antiHPTNsive in critical care in pre-eclampsia or eclampsia
IV hydralazine
38
What is given in labour and 24 hours after to prevent seizures
IV mg sulphate
39
Why is there a risk of fluid overload in pre-eclampsia/eclampsia
40
When is planned early birth necessary
BP cannot be controlled or complications occur Give corticosteroids
41
What medical treatmnet to switch to after delivery for pre-eclampsia
Enalapril - 1st line Nifedipine or amlodipine - 1st line in black african or caribbean patients Labetolol or atenolol
42
Treatment for seizures ass with eclampsia
IV mg sulphate
43
What is HELLP syndrome
Features that occur as complication of pre eclampsia and eclmapsia Haemolysis Elevated Liver enzymes Low Platelets
44
What mechanism causes pre-eclampsia
Oxidatiev stress leading to inflammation Increased vascular permeability Increased prothrombic factors Increased platelet aggregation Vasoconstriction End organ dysfunction/damage
45
What is pre-eclampsia complication
HELLP syndrome Baby needs to be out
46
When are people induced with pre-eclampsia even if its well controlled
37 weeks
47
Can you carry til term with well ctonrolled hypertension
yes
48
Why is it hard to do a C section with HELLP
Problems with coagulation
49
What effect does pre-eclampsia have on labour
Makes it really quick Full labour in 1-2 hours

Reproductive Health (69 decks)

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