Pregnancy complications - Pre-eclampsia and Eclampsia Flashcards
(62 cards)
What is pre-eclampsia?
A hypertensive syndrome that occurs in pregnant women after 20 weeks’ gestation, consisting of new-onset, persistent hypertension (defined as a BP of ≥140 mmHg systolic and/or ≥90 mmHg diastolic, based on at least 2 measurements taken at least 4 hours apart) with either proteinuria (defined as urinary excretion of ≥0.3 g protein/24 hours) or evidence of systemic involvement.
What is thought to be the main pathophysiological cause of pre-eclampsia?
- Disorder of placentation, primary defect i sfailure of trophoblast invasion of spinal arteries which leads to uteroplacental ischaemia and wide spread endothelial dysfunction
- HIGH RESISTANCE, LOW FLOW PLACENTA so suboptimal uroplacental perfusion
Failure of trophoblastic invasion of spiral arteries, leaving them vasoactive. This leaves them unable to clamp down in response to vasoconstrictors, and this protects placental flow. The dysfunctional placenta releases pro-inflammatory mediators, which increase BP (hypertension) and make vessels more leaky (oedema). They also affect the kidneys (proteinuria) and even the liver
When does pre-eclampsia manifest?
>20 weeks gestation
How long after delivery does pre-eclampsia resolve?
Roughy 6 weeks
What are risk factors for pre-eclampsia?
- Previous pre-eclampsia/Early onset
-
Underlying PMH
- Chronic hypertension - current or previous pregnancy
- CKD
- DM
- Autoimmune disease - SLE, antiphospholipid, thrombophilia
- 1st pregnancy
- >40 yrs, <20
- FH pre-eclampsia
- Multiple pregnancy
- Low PAPP-A
- BMI >/= 30
What are complications fo pre-eclampsia?
- Eclampsia
- HELLP
- Cerebral haemorrhage
- IUGR
- Renal Failure
- Placental abruption
- DIC
What cut off for blood pressure is used in defining pre-eclampsia?
- SBP > 140
- DBP > 90
What level of protein in the urine is used to define pre-eclampsia?
Urinary protein ≥0.3 g protein/24 hours
What are the physiological effects of pre-eclampsia?
- Decreased plasma volume
- Increased peripheral vascular resistance
- Placental ischaemia
- If BP > 180/140 - microaneurysms develop in arteries
What are symptoms of pre-eclampsia?
May be asymptomatic (often picked up on screening), or:
- Headache, usually frontal
- Blurred vision, flashing lights/floaters
- Epigastric/RUQ pain
- Nausea and vomiting
-
Swelling of face/fingers/lower limbs
- Rapid onset
- Esp face
What are signs of pre-eclampsia?
- Tachycardia
- Hypertension
- Proteinura
- Epigastric/RUQ tenderness
- Reduced foetal movements
- Hyperreflexia
- >2 beats clonus
- Confusion
- Oliguria
- Fits
- Oedema
What signs are red flags?
Hyper-reflexia, clonus
What investigations would you consider doing in someone with suspected pre-eclampsia?
- Bedside - Dipstick, Basic observations, foetal CTG, consider fundoscopy
- Bloods - FBC, LFTs, U+E’s, Coag screening
- Imaging - Foetal USS, Umbilical artery doppler velocimetry
- Other - Amniotic fluid assessment, consider MSSU
Whats the gold standard investigation?
URINARLYSIS
What might you see on urinalysis in pre-eclampsia?
Proteinuria
What might the preotin:creatinine ratio be in someone with Pre-eclampsia?
>30 mg/mmol
Why might you do foetal ultrasound in someone with pre-eclampsia?
Due to reduced foetal movements - always requires and ultrasound
What might you see on FBC in someone with pre-eclampsia?
- Thrombocytopenia
- Anaemia (haemolysis)
What might you find on LFT in someone with pre-eclampsia?
May be elevated
What might coagulation tests show?
A raised PT - if severe or thrombocytopenia
What might you find on foetal CTG in someone with pre-eclampsia?
Signs of foetal distress
What might you find on investigation of coag screen in someone wtih pre-eclampsia?
May be normal, but PT or APTT may be prolonged in DIC
What might you find on foetal USS?
- IUGR
- Oligohydramnios
What might you find on doppler USS of umbilical arteries and uterus in someone with pre-eclampsia?
- Notching of the uterine arteries
- Abnormal umbilical artery
