Pre-eclampsia

Question 1

What is pre-eclampsia?

Answer 1

New high blood pressure in pregnancy with end-organ dysfunction, notably proteinuria

Occurs after 20 weeks gestation when spiral arteries of placenta form abnormally, leading to high vascular resistance.

Question 2

What defines chronic hypertension in pregnancy?

Answer 2

Hypertension prior to 20 weeks gestation and is longstanding, not caused by dysfunction in placenta

Question 3

What is pregnancy-induced hypertension?

Answer 3

Hypertension occurring after 20 weeks gestation without proteinuria

Question 4

What is the relationship between pre-eclampsia and proteinuria?

Answer 4

Pre-eclampsia is pregnancy-induced hypertension with organ damage and proteinuria

Question 5

What is eclampsia?

Answer 5

Seizures occur as a result of pre-eclampsia

Question 6

List high-risk factors for pre-eclampsia

Answer 6

• Pre-existing hypertension
• Previous hypertension in pregnancy
• Existing autoimmune disease (e.g. SLE)
• Diabetes
• Chronic kidney disease

Question 7

List moderate-risk factors for pre-eclampsia

Answer 7

• > 40 years old
• BMI >35
• > 10 years since previous pregnancy
• Multiple pregnancy
• First pregnancy
• Family history of pre-eclampsia

Question 8

What are the classic triad features of pre-eclampsia?

Answer 8

• Hypertension
• Proteinuria
• Oedema

Question 9

What are other symptoms of pre-eclampsia?

Answer 9

• Headache
• Visual disturbance
• Nausea and vomiting
• Upper abdominal or epigastric pain
• Reduced urine output
• Brisk reflexes

Question 10

What blood pressure readings indicate a diagnosis of pre-eclampsia according to NICE 2019?

Answer 10

Systolic BP >140mmHg and diastolic BP >90mmHg

Question 11

What additional criteria can confirm a diagnosis of pre-eclampsia?

Answer 11

• Proteinuria (PCR ratio >30; ACR ratio >8)
• Organ dysfunction (e.g. raised creatinine, elevated liver enzymes)
• Placental dysfunction (e.g. fetal growth restriction)

Question 12

What is the prophylactic treatment for high-risk individuals in pre-eclampsia?

Answer 12

Aspirin given from 12 weeks until birth

Question 13

What is the target blood pressure for gestational hypertension without proteinuria?

Answer 13

Aim for BP <135/85

Question 14

What is the management for severe pre-eclampsia?

Answer 14

• Labetalol (1st line)
• Nifedipine (2nd line)
• Methyldopa (3rd line)
• IV hydralazine (in severe cases)
• IV magnesium sulphate (during labor and 24hrs after)

Question 15

What is the purpose of corticosteroids in planned early birth for pre-eclampsia?

Answer 15

To help mature fetal lungs

Question 16

What is HELLP syndrome?

Answer 16

A combination of features that occur as a complication of pre-eclampsia and eclampsia

Question 17

What does HELLP stand for?

Answer 17

• H: Haemolysis
• E: Elevated Liver enzymes
• L: Low Platelets

Question 18

How is eclampsia managed?

Answer 18

With IV magnesium sulphate

Question 19

Fill in the blank: Pre-eclampsia occurs after _______ weeks gestation.

Answer 19

20