Preeclampsia

Question 1

Preeclampsia is defined as..

Answer 1

An abnormal condition of pregnancy characterised by onset of acute hypertension after the 24th week of gestation

Question 2

Signs of preeclampsia

Answer 2

Hypertension
Proteinuria
Oedema

Question 3

Percentage of all pregnancy affected by preeclampsia

Answer 3

5-8%

Question 4

Incidence of PE increases with

Answer 4

Gestational age of mother

Multiple gestations

Question 5

Mild form of PE

Answer 5

Systolic BP >140mmHg and diastolic >90mmHg

Question 6

Severe form of PE

Answer 6

Systolic BP >160mmHG and diastolic >110mmHg

Question 7

First stage of defective trophoblast invasion

Answer 7

Occurs early in pregnancy

Question 8

Uteroplacental circulation remaining in a state of high resistance can be detected by..

Answer 8

Increased resistance of the uterine arteries

Albaiges et al., 2000

Question 9

Persistant state of underperfusion produces..

Answer 9

Placental hypoxia and oxidative stress

Question 10

Systemic inflammatory response and endothelial dysfunction leads to..

Answer 10

the onset of clinical symptoms of PE

Ness and Roberts, 1996

Question 11

Studies show PE disease with strong familial predisposition

Answer 11

Reported that women with first-degree relatives with PE have 5 times more risk of developing
Those with second-degree have double the risk
(Graves 1998, Salonen 2000)

Question 12

Goddard et al 2007 study

Answer 12

Evaluated 775SNPs in 190 genes in >350 PE mother and offspring pairs

Question 13

Goddard et al 2007 detected..

Answer 13

6 genes with a significant maternal-foetal genotype interaction related to PE

Question 14

Goddard et al 2007 6 genes..

Answer 14

IGF1
IL4R
GNB3
CSF1
THBS4

Question 15

Multifactorial polygenic inheritance with..

Answer 15

A genetic component in the development of PE

Trogstad et al., 2004

Question 16

Uteroplacental variations in renin-angiotensin system

Answer 16

ACVR2

STOX1

Question 17

Placental angiogenesis heritable variations

Answer 17

PIGF
VEGF
Flt-1
Endogelin

Question 18

Sovio et al study

Answer 18

Showed that the ratio of sFlt to PIGF can be used as a predictive value of PE

Question 19

Single association signal close to Fms-like tyrosine kinase 1 on what chromosome

Answer 19

13

Question 20

Fms-like tyrosine kinase 1 encodes

Answer 20

Soluble Fms-like tyrosine kinase 1

a splice variant of the VEGF

Question 21

What does soluble Fms-like tyrosine kinase

Answer 21

Exerts antiangiogenic activity by inhibiting signalling of proangiogenic factos

Question 22

Fms-like tyrosine kinase 1 pathway is central in preeclampsia pathogenesis because..

Answer 22

Excess circulating soluble Fms-like tyrosine kinase 1 in the maternal plasma leads to hallmark features of PE
(Gray et al 2018)

Question 23

Obesity increases overall risk of preeclampsia by..

Answer 23

2-3 fold

Bodnar et al 2005

Question 24

Risk of preeclampsia increases with..

obesity

Answer 24

Increasing BMI

Question 25

Increased risk of PE is present in..

Answer 25

Caucasian and African-American women | Bodnar et al 2007

Question 26

Features of obesity that provide insight into pathophysiology of PE

Answer 26

Inflammation | Oxidative stress

Question 27

Inflammation and PE

Answer 27

Adipose tissue generates several inflammatory mediators that can alter endothelial function Produced more actively in obese individuals

Question 28

Circulating C-reactive protein are

Answer 28

Inflammatory mediators produced by the liver as well as adipocytes

Question 29

Circulating C-reactive proteins are elevated in..

Answer 29

Early pregnancy prior to development of PE

Question 30

Wolf et al 2001 showed

Answer 30

Strong assocation with PE and obese women | circulating C-reactive proteins

Question 31

Interleukin-6 is a

Answer 31

Potent inflammatory mediator

Question 32

Interleukin-6 leads to

Answer 32

Vascular damage and is associated with obesity and insulin resistance Grimble 2002

Question 33

Tumour necrosis factor alpha (TNF-α) is also produced in adipose tissue BUT

Answer 33

Studies have shown that TNF-α is not higher in obese pregnant women compared to non-obese controls Founds et al 2008

Question 34

Autophagy plays an important role in..

Answer 34

Trophoblast function under physiologically low oxygen conditions in normal pregnancy

Question 35

Autophagy is a process of..

Answer 35

Self-degradation of cellular components in which double-membrane autophagosomes sequester organelles and fucse with lysosomes so that the contents can be digested by lysosomes Mizushima et al 2010

Question 36

Autophagy is important in

Answer 36

Extravillous trophoblasts (EVT) invasion and vascular remodelling under physiologically low oxygen conditions

Question 37

EVTS invade the..

Answer 37

Uterine myometrium up to 1/3 in depth and migrate along the lumina of spiral arterioles replacing the maternal endothelial lining

Question 38

Autophagy impaired by sENG may be involved in.. (4 things) Saito and Nakashima 2013

Answer 38

Poor placentation due to impairedEVT invasion and poor vascular remodelling Systemic inflammation by activating inflammasome and induction of ER stress Inadequate tolerance by reducing the pool of Treg cells in PE

Question 39

Cure of PE

Answer 39

Delivering the baby | NHS, 2018

Question 40

Treatment for severe PE

Answer 40

Hospitalisation and complete bedrest High protein diet to compensate for loss of protein and increase nutrients for foetus Magnesium sulphate (4-7.5 mEg/L) helps excretion of fluid to reduce BP and in more severe cases stop convulsions and seizures

Question 41

Complications

Answer 41

High mortality if undiagnosed Risk of cerebral haemorrhave Circulatory collapse Renal failure