Pre-eclampsia/eclampsia IAIs

Question 1

Pre-eclampsia/eclampsia IAIs

ASAP:

Answer 1

ASAP: ABCs, IVs, O2, monitor, VS, FHT, Toco, L lateral decubitus position

Question 2

Pre-eclampsia/eclampsia IAIs

History and Exam:

Answer 2

Hx/exam: HA, vision changes, abd pain, edema, pulm edema, HTN systolic >140 or diastolic >90, hyperreflexia, tachycardia, clonus

Question 3

Pre-eclampsia/eclampsia IAIs

Labs:

Answer 3

Labs: CBC, BUN/Cr, lytes, gluc, Ca/Mg/Phos, LFTs, UA, coags, D-dimer, fibrinogen, uric acid

Question 4

Pre-eclampsia/eclampsia IAIs

DDx:

Answer 4

DDx: pre-E, eclampsia, HELLP

Question 5

Pre-eclampsia/eclampsia IAIs

Preeclampsia Definition:

Answer 5

BP:
≥ 140 systolic or ≥ 90 diastolic on two occasions at least 4 hours apart after 20 weeks in a woman with previously normal blood pressures
≥ 160 systolic or ≥ 110 diastolic (HTN can be confirmed within a short interval to facilitate timely therapy)

Proteinuria:
≥ 300 mg/24 hr
Protein/Cr ≥ 0.3
Dipstick reading of 1+

Absence of proteinuria, new onset HTN with new onset of any of following Thrombocytopenia: <100,000
Renal insufficiency: Cr > 1.1 or double of Cr with absence of other renal disease
Impaired liver function: elevated AST/ALT twice normal
Pulmonary edema
Cerebral or visual symptoms

Question 6

Pre-eclampsia/eclampsia IAIs

Severe preeclampsia definition:

Answer 6

≥ 160 systolic or ≥ 110 diastolic + thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, cerebral or visual disturbances

Question 7

Pre-eclampsia/eclampsia IAIs

Eclampsia definition:

Answer 7

Eclampsia
Presence of new-onset seizure in women with preeclampsia

Question 8

Pre-eclampsia/eclampsia IAIs

HELLP syndrome definition

Answer 8

Hemolysis
Elevated liver enzymes
Low platelets

Question 9

Pre-eclampsia/eclampsia IAIs

Pre-eclampsia Tx:

Answer 9

IVF
If BP > 160/100​ treat HTN. Goal BP is < 150/95

Question 10

Pre-eclampsia/eclampsia IAIs

If severe pre-E Treatment

Answer 10

sz prophylaxis w/ Mg 4-6 gm IV over 20 min, then 2 gm/hr (therapeutic level 4-6 mEq/L)

Question 11

Pre-eclampsia/eclampsia IAIs

If Eclampsia (szs) treatment:

Answer 11

Mg 6gm IV over 5 min, then 2 gm/hr. Midazolam or Barbiturates for refractory sz.
True tx is Delivery!
(Follow Mg levels and exam: hold Mg if bradycardia, loss of DTRs, resp depression Antidote for Mg toxicity is Ca)