12.1 Pre-eclampsia

Question 1

What are the risk factors of pre-eclampsia?

Answer 1

• First pregnancy
• Previous history of pre eclampsia
• BMI >35
• Multiple pregnancy
• >40 years of age
• Pregnancy interval >10 years
• Underlying medical conditions: DM, Renal ds, Hypertension
• Donor eggs/embryo

Question 2

What are the classifications for someone to have pre-eclampsia?

Answer 2

• Chronic Hypertension
• PIH (Pregnancy-induced hypertension)
• PIH + Proteinuria
• Proteinuria without Hypertension

Question 3

What is the pathophysiology behind pre-eclampsia?

Answer 3

• Is a multi-system disorder
• Trophoplastic involvement
• Endothelial dysfunction
• Poorly perfused placenta

Question 4

What is the reccurance risk of pre-eclampsia?

Answer 4

Chances of pre-eclampsia & chronic hypertension = 20-50%

Question 5

What are the multiple systems affected in pre-eclampsia?

Answer 5

• Neurological e.g.
  
  • Stroke
  • Fits
• Hepatic
• Renal
  
  • Oliguria (a decreased urine output)
  • Proteinuria
• Haematological

Question 6

What are the complications of pre-eclampsia (maternal & fetal)?

Answer 6

Maternal

• Seizures
• Pulmonary oedema
• Placental abruption
• CV event
• Stroke
• Death

Fetal

• IUGR (Intrauterine growth restriction refers to poor growth of a fetus while in the mother’s womb)
• Prematurity
• Hypertension
• Stroke
• Demise

Question 7

What are the signs & symptoms of pre-eclampsia?

Answer 7

SYMPTOMS

• Headache
• Nausea & Vomiting
• Visual disturbances
• Oedema
• Epigastric pain
• Oliguria

SIGNS

• Papilloedema (optic disc swelling that is caused by increased intracranial pressure)
• Clonus (neurological condition that creates involuntary muscle contractions)
• Hyper-reflexia
• Low Platelets
• High Creatinine
• High ALT
• Haemolysis (drop in Hb)

Question 8

What investigations would you do to diagnose someone with pre-eclampsia?

Answer 8

• Blood pressure
  
  • HIGH BP (>140/90)
    
    • Would usually fall in a normal pregnancy
• Urine analysis
  
  • Could be proteinuria
• Blood tests
  
  • ​FBC, clotting factor, LFTs, U&Es
• Ultrasound
  
  • ​Check for fetal growth & well-being
  • Check maternal uterine blood flow

Question 9

Explain prevention & prediction of pre-eclampsia?

Answer 9

Prevention

1. Primary prevention not possible as cause unknown
2. Secondary prevention-observational studies suggest that HEPARIN reduces recurrence in women with thrombophilia (imbalance in clotting factors) & surveillance

• ASPIRIN = risk reduction

PREDICTION

• Angiogenic factor (sFlt-1) from simple urinary test
• PIGF (placental growth factor synthesised by syncytiotrophoblast)
• Ultrasound

Question 10

What is the pharmacological intervention in pre-eclampsia?

Answer 10

• Control BP
  
  • ​Antihypertensives
    
    • e.g. Labetatol/Hydralazine
• Reduce risk of seizure
  
  • Magnesium sulphate
• To benefit fetus
  
  • Steroid for lung maturation
    
    • E.g. Betamethasone/Dexamethasone

Question 11

What is the effect of magnesium on pre-eclampsia?

Answer 11

• Vasodilator
• Neuroprotective
• Excreted by kidneys
  
  • Toxicity
• Antidote
  
  • Calcium gluconate

Question 12

Explain the management for pre-eclampsia

Answer 12

• MDT involvement
• Fluid restriction
• Observation (BP/pulse/resp rate/urine output/reflexes)
• Bloods, Biochemistry and Urinary protein monitoring
• Drugs (Anti-hypertensives, Magnesium Sulphate, Steroids)
• Fetal monitoring

(Mother takes priority over fetus )

Question 13

Explain what happens after delivery of the baby & the follow-up (FU)

Answer 13

• VD (vaginal delivery) vs CS (caesarean section) (depends on gestation and severity of condition)
• Continue Mag Sulph for 24 hrs
• Monitor bloods and biochem & BP
• Arrange POST NATAL FU (follow-up)

Question 14

What are the complications of pre-eclampsia?

Answer 14

ECLAMPSIA (severe)

• Seizures
• Mortality 1:50
• Obstetric Emergency
• Magnesium sulphate IV
• Stabilise mother and deliver

HELLP

Haemolysis

Elevated Liver enzymes

Low Platelets

• Incidence 10-20%
• Results from endothelial damage
• Risk of DIC (Disseminated intravascular coagulation)
  
  • Begins with excessive clotting