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Pre Eclamsia Flashcards

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1
Q

What is the definition of Chronic Hypertension in pregnancy according to the document?

A

Pre-existing hypertension or hypertension detected before the 20th week of gestation (not due to trophoblastic disease) that persists for more than 6 weeks postpartum.

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2
Q

How is Gestational Hypertension (PIH) defined?

A

Hypertension developing after 20 weeks of gestation in a previously normotensive woman without proteinuria, resolving within 42 days (6 weeks) of delivery.

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3
Q

What are the key characteristics of Pre-eclampsia?

A

A pregnancy-specific syndrome, typically occurring after 20 weeks, characterized by new-onset hypertension and proteinuria or other signs of end-organ dysfunction.

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4
Q

Define Eclampsia.

A

The occurrence of seizures in a woman with pre-eclampsia that cannot be attributed to other causes.

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5
Q

How is Pre-eclampsia Superimposed on Chronic Hypertension defined?

A

Development of new-onset proteinuria, a sudden increase in proteinuria, worsening hypertension, or other signs of end-organ dysfunction after 20 weeks in a woman with chronic hypertension.

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6
Q

How is Proteinuria defined by urine dipstick in the document?

A

> 2+ (or > 30mg/dL)

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7
Q

How is Proteinuria defined by 24-hour urine collection?

A

> 300mg/day

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8
Q

How is Proteinuria defined by Urine Protein/Creatinine Ratio (UPCR)?

A

> 30mg/mmol (or 0.3 mg/mg)

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9
Q

What is Severe Pre-eclampsia (Impending Eclampsia)?

A

Pre-eclampsia with features indicating high risk for eclampsia or other severe complications.

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10
Q

What is the approximate rate of Pre-eclampsia per pregnancies mentioned?

A

5 per 1000 pregnancies

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11
Q

Approximately what percentage of Eclampsia cases occur antepartum?

A

~30%

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12
Q

Approximately what percentage of Eclampsia cases occur postpartum?

A

~50%

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13
Q

Approximately what percentage of Pre-eclampsia cases occur antepartum?

A

~45%

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14
Q

Approximately what percentage of Pre-eclampsia cases occur intrapartum?

A

~18%

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15
Q

Approximately what percentage of Pre-eclampsia cases occur postpartum?

A

~33%

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16
Q

What is the approximate rate of Eclampsia per pregnancies mentioned?

A

5 per 10,000 pregnancies

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17
Q

What is the primary event linked to the pathophysiology of pre-eclampsia?

A

Poor placentation early in pregnancy.

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18
Q

What happens to the spiral arteries in abnormal placentation in pre-eclampsia?

A

Abnormal development leads to placental underperfusion, hypoxia, and oxidative stress.

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19
Q

What factors are released into the maternal circulation due to placental underperfusion?

A

Antiangiogenic factors.

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20
Q

What do the released antiangiogenic factors cause systemically?

A

Systemic endothelial dysfunction.

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21
Q

Systemic endothelial dysfunction in pre-eclampsia leads to what main clinical manifestations?

A

Hypertension and multi-organ involvement.

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22
Q

Which organs can be involved in pre-eclampsia due to endothelial dysfunction?

A

Hematologic, neurologic, cardiac, pulmonary, renal, hepatic.

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23
Q

List three maternal risk factors for pre-eclampsia.

A

First pregnancy, previous pre-eclampsia, family history, age <20 or >35, chronic hypertension, CKD, APLS, GDM, obesity, low maternal birth weight, Rh disease, ART/Donor IUI, >10 years since last baby, booking diastolic BP $\ge80$ mmHg, booking proteinuria. (Any three from this list)

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24
Q

List three fetal risk factors for pre-eclampsia.

A

Multiple pregnancy, Hydatidiform mole, advancing gestational age, triploidy. (Any three from this list)

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25
Is Antiphospholipid syndrome a risk factor for pre-eclampsia?
Yes.
26
What are the two primary clinical features of pre-eclampsia?
Hypertension and Proteinuria.
27
Besides hypertension and proteinuria, list three other clinical features of pre-eclampsia mentioned.
Headache (frontal), Visual disturbances (blurring, flashing lights, scotomata), Epigastric pain, Nausea/Vomiting, Rapidly progressive edema (hands, face), Hyperreflexia, Clonus (>3 beats), Oliguria, Fetal growth restriction (FGR). (Any three from this list)
28
What does HELLP syndrome stand for?
Hemolysis, Elevated Liver enzymes, Low Platelets.
29
What does HELLP syndrome indicate in the context of pre-eclampsia?
Severe disease.
30
What is the major complication characterized by seizures in a woman with pre-eclampsia?
Eclampsia.
31
What factors are used to assess the severity of pre-eclampsia?
Blood pressure levels, degree of proteinuria, presence of symptoms (headache, visual changes, epigastric pain), and evidence of end-organ dysfunction (renal, hepatic, hematologic, neurologic).
32
What maternal investigation is used for diagnosing/monitoring proteinuria?
Urine Ward Test (UWT)/Dipstick.
33
Which maternal blood test is used to assess for HELLP syndrome (specifically Hb and Platelets)?
Full Blood Count (FBC).
34
Which maternal blood test assesses liver damage?
Liver Function Tests (LFTs) - AST/ALT.
35
Which maternal blood tests assess kidney function?
Renal Function Tests (RFTs) - Serum Creatinine (S.Cr), BUN.
36
What is the purpose of a Urine Full Report (UFR) in investigating pre-eclampsia?
To confirm proteinuria and exclude UTI.
37
Which maternal blood test is used to exclude coagulopathy?
Coagulation Profile (PT/INR).
38
What is the initial assessment for fetal well-being?
Fetal Heart Sounds (FHS).
39
What investigation is often used to assess fetal well-being if clinically indicated?
Cardiotocography (CTG).
40
What fetal parameters are assessed by Ultrasound Scan (USS) for growth?
Head Circumference (HC), Abdominal Circumference (AC), Estimated Fetal Weight (EFW).
41
What fetal parameters are assessed by Ultrasound Scan (USS) for well-being?
Amniotic Fluid Index (AFI), fetal movements, tone, Doppler studies (Umbilical Artery - UA, Middle Cerebral Artery - MCA).
42
What is a key goal of pre-conceptional care for women with chronic hypertension?
Optimize underlying medical conditions and achieve optimal BP control.
43
What is the general target BP control in pre-conception for chronic hypertension?
<150/100 mmHg generally, <140/90 mmHg with end-organ damage.
44
Which antihypertensive drugs should be AVOIDED in pregnancy due to fetal risks?
ACE inhibitors, ARBs, Atenolol, Thiazide diuretics.
45
What is the goal of antenatal management in hypertensive disorders of pregnancy?
Healthy mother and healthy baby.
46
What is the 1st choice oral pharmacotherapy for Mild-Moderate HTN in pregnancy according to the document (Sri Lanka)?
Oral Nifedipine Slow Release.
47
What is the 2nd choice oral pharmacotherapy for Mild-Moderate HTN?
Methyldopa.
48
What is the 3rd choice oral pharmacotherapy for Mild-Moderate HTN?
Labetalol.
49
What is the preferred IV therapy for severe HTN if available and no contraindications?
IV Labetalol.
50
What is an alternative IV therapy for severe HTN, used cautiously as it can worsen tachycardia?
IV Hydralazine.
51
What is the target diastolic BP for chronic/maintenance management based on the CHIPS trial?
Aim for diastolic BP of 85 mmHg.
52
What medication is recommended for prevention of pre-eclampsia in high-risk women from 12 weeks until delivery?
Low-dose Aspirin (75-150 mg daily).
53
What supplementation is recommended for prevention of pre-eclampsia from 20 weeks, especially if baseline intake is low?
Calcium Supplementation (at least 1000 mg daily, recommended 600mg in Sri Lanka).
54
How is maternal surveillance typically conducted in antenatal management?
Regular BP monitoring, regular proteinuria assessment, baseline and periodic blood tests (FBC, RFT, LFT) depending on severity.
55
When is CTG usually performed in antenatal management of hypertensive disorders?
Usually only if clinically indicated (e.g., reduced fetal movements) or on admission for severe disease.
56
What is the definitive cure for Pre-eclampsia?
Delivery of the baby and placenta.
57
What medication is used for eclampsia prophylaxis and treatment?
Magnesium Sulfate (MgSO4).
58
How long after delivery should antihypertensive medications typically be reviewed?
In 2 weeks.
59
When is a medical review recommended postpartum?
At 6-8 weeks postpartum.
60
What contraception advice is given regarding COCP if HTN is uncontrolled postpartum?
Avoid COCP.
61
What is the maximum daily dose range for Oral Nifedipine Slow Release?
80-120mg/day.
62
What is the maximum daily dose for Methyldopa?
3g/day.
63
What is the maximum daily dose for Oral Labetalol?
2400mg/day.
64
What BP threshold generally indicates severe HTN requiring acute management with oral agents?
BP 160/110-180/110 mmHg.
65
What BP threshold generally indicates severe HTN requiring IV therapy or if unresponsive to oral agents?
BP > 180/110 mmHg or unresponsive to oral.
66
What is the initial dose and repeat frequency for Oral Labetalol in acute severe HTN management?
200mg stat, repeat once in 30min.
67
What is the initial dose and repeat frequency for Oral Nifedipine Quick-Release in acute severe HTN management?
10mg, repeat q20min up to 40mg.
68
Why should sublingual Nifedipine Quick-Release be avoided?
Avoid sublingual administration.
69
What is the initial loading dose for IV Labetalol?
20-50mg.
70
What is the maximum cumulative dose for IV Labetalol loading doses?
Max 200mg cumulative (up to 4 doses).
71
What is the initial bolus dose and repeat frequency for IV Hydralazine?
5-10mg bolus over 2 min, repeat bolus q20min if needed.
72
Based on the CHIPS trial target, when should antihypertensive drugs be stopped?
If BP < 110/70 mmHg.
73
From what gestational age is low-dose Aspirin recommended for prevention of pre-eclampsia, and until when?
From 12 weeks until delivery.
74
From what gestational age is Calcium supplementation recommended for prevention of pre-eclampsia?
From 20 weeks.
75
In what specific postpartum scenario is screening for APLS recommended?
If pre-eclampsia onset <34w and delivery <32w.
76
From what gestational age are Kick Counts (KCC) advised?
From 36 weeks.

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