Pre-eclampsia

Question 1

What is chronic hypertension?

Answer 1

• Hypertension either known prior to pregnancy, or picked up before 20 weeks gestation.
• In early pregnancy, systemic vascular resistance falls, and cardiac
  output does not catch up with this until ~22 weeks.
  • This means that BP is usually lower in the first and most of the second trimester.
  • Therefore hypertension detected before 20 weeks gestation is not related to the pregnancy.

Question 2

What is gestational hypertension?

Answer 2

• Pregnancy induced hypertension = new onset of hypertension after 20 weeks gestation
• New onset BP > 140/90 in the absence of features of pre-eclampsia.

Question 3

What is the diagnostic criteria for pre-eclampsia?

Answer 3

• Pre-eclampsia is a hypertensive disorder which can occur in pregnancy.
• Multi-system condition.
  • Can affect kidneys, liver, brain, eyes, and other organs.
  • Associated with complications for mother and fetus.
• Affects between 1-5% of pregnant women.
• It usually develops between 20 weeks’ gestation, and 6 weeks post- partum
• Diagnostic criteria:
  • Blood pressure >140/90
  AND
  • Significant proteinuria

Question 4

What are the risk factors for pre-eclampsia?

Answer 4

Question 5

What is the pathophysiology for pre-eclampsia?

Answer 5

abnormal development of placental vessels (spiral arteries). They should dilate up to 5- 10x their normal size to increase blood flow to the foetus. In pre-eclampsia they are narrowed → less blood flow through placenta

Question 6

What are the maternal and feral effects of pre-eclampsia?

Answer 6

Question 7

What are the symptoms and complications of pre-eclampsia?

Answer 7

Question 8

What are the investigations for pre-eclampsia?

Answer 8

Question 9

What is the management of eclampsia and pre-eclampsia?

Answer 9

Management Of eclampsia:

• Obstetric emergency call.
• IV Magnesium sulphate for prevention and treatment.
• IV antihypertensives (labetalol or hydralazine).
• Continuous monitoring of mother and baby.
• Prompt delivery of fetus (emergency C-Section) once mother stable.