Pre-eclampsia

Question 1

What is this describing?

New hypertension after 20/40 with significant proteinuria. Only cured by delivery of the placenta.

Answer 1

Pre-eclampsia

Question 2

What is the difference between early and late onset pre-eclampsia?

Answer 2

1. <34/40, foetus growth typically restricted.

2. >34/40, not associated with IUGR usually.

Question 3

What causes pre-eclampsia?

Answer 3

1. Poor placental perfusion, oxidative stress.
2. Placenta oversecretes angiogenic regulating proteins.
3. Increased sFlt-1 and reduced PIGF levels in maternal blood.

Question 4

What are the high-risk factors for pre-eclampsia?

Answer 4

Chronic HTN, history of pre-eclamptic toxaemia, history of gestational HTN, CKD, DM, SLE, antiphospholipid syndrome.

Question 5

What are the moderate-risk factors for pre-eclampsia?

Answer 5

1st pregnancy, 10 year interpregnancy interval, >40 years old, BMI >30, family history pre-eclamptic toxaemia, multiple pregnancy.

Question 6

What is the indication for prescribing aspirin in pre-eclampsia, what is the dose, and when is it given?

Answer 6

1. 1 high-risk or 2/more moderate-risk factors present
2. 75-150mg per day
3. From 12/40

Question 7

How are mild, moderate, and severe pre-eclampsia classified?

Answer 7

1. Mild - 140/90-149/99
2. Moderate - 150/100-159/109
3. 160/110+, or any symptoms of pre-eclamptic toxaemia/biochemical/haematological abnormalities.

Question 8

What are the maternal complications of pre-eclampsia?

Answer 8

1. Eclampsia - GTCS
2. Cerebrovascular haemorrhage
3. HELLP syndrome
4. Renal failure
5. Pulmonary oedema

Question 9

What are the foetal complications of pre-eclampsia?

Answer 9

1. In early onset - IUGR
2. Increased morbidity and mortality
3. Placental abruption

Question 10

What is this a presentation of?
Asymptomatic initially. Later: atypical headaches, drowsiness, visual disturbances, nausea, vomiting, epigastric pain, high blood pressure, peripheral oedema.

Answer 10

Pre-eclampsia

Question 11

How is suspected pre-eclampsia identified?

Answer 11

1. Blood pressure

2. PCR >30mg/mmol

Question 12

How are women with pre-eclampsia screened for complications?

Answer 12

1. FBC (anaemia in haemolysis)
2. LFTs and clotting (raised transaminases, PT, and aPTT)
3. LDH - raised in haemolysis
4. U&Es (raised creatinine)

Question 13

What is the screening for foetal abnormalities in pre-eclampsia?

Answer 13

1. USS (oligohydramnios, IUGR)
2. Abnormal umbilical artery doppler
3. Notching of uterine arteries on doppler
4. CTG

Question 14

When should antihypertensives be started and which are used in pre-eclampsia?

Answer 14

1. When BP >150/100

2. PO Nifedipine initial control, labetalol for maintenance (aim for 140/90)

Question 15

What should be done with a pregnant lady with pre-eclampsia at 37/40?

Answer 15

Admit and induce labour (only at 37/40)

Question 16

What is used in severe pre-eclampsia to prevent seizures, what does toxicity of this medication cause, and when should it be stopped?

Answer 16

1. Magnesium sulphate
2. Respiratory depression, hypotension, loss of patella reflexes precedes this.
3. Stop in renal impairment/if oliguria develops.

Question 17

What are steroids used for in pre-eclampsia and under how many weeks pregnant can you give them?

Answer 17

1. Promote foetal lung maturity

2. <34/40

Question 18

What is the process for delivery in pre-eclampsia at >34/40?

Answer 18

Induction of labour using prostaglandins

Question 19

What is the process for delivery in pre-eclampsia at <34/40?

Answer 19

C-section

Question 20

What drug should not be used in the third stage of labour in pre-eclampsia?

Answer 20

Ergometrine

Question 21

What is the postnatal management of pre-eclampsia?

Answer 21

1. Monitor LFTs, clotting, and U&Es
2. Strict fluid balance
3. Strict BP control, beta-blockers for at least 5 days