Pre-eclampsia

Question 1

What is pre-eclampsia?

Answer 1

Complication of pregnancy
High blood pressure AND proteinuria
Occurs after 20wks and can start up to 6 weeks post-partum
Can develop into eclampsia

Question 2

What is eclampsia?

Answer 2

Complication of pregnancy
Maternal seizures
Obstetrics emergency

Question 3

Types of hypertension in pregnancy

Answer 3

Chronic hypertension - pre-existing HTN
Gestation hypertension (PIH) - new HTN onset during pregnancy >20wks
Pre-eclampsia - HTN + proteinuria

Question 4

pre-eclampsia epidemiology

Answer 4

Affects 1-5% of pregnant people
Risk is highest in the first pregnancy (P0)
Risk is increased if you have had pre-eclampsia in previous pregnancies (higher risk if these are also pre-term)

Question 5

Factors causing a high risk of pre-eclampsia

Answer 5

1 of the following high risk:
Hx of HTN in pregnancy
CKD
Autoimmune diseases
T1/2DM
Chronic HTN

or 2 of the following moderate risk:
Parity 0
>40 yrs
Pregnancy interval >10yrs
BMI >35 pre-pregnancy
FHx of pre-eclampsia
Multiple pregnancies

Also consider African/ Caribbean ethnicity

Question 6

Prevention of pre-eclampsia

Answer 6

If you have 1 high risk/ 2 moderate risk factors - prophylactic Aspirin from G12wks
(+ lifestyle modification, and management of other co-morbidities)

Question 7

pre-eclampsia presentation

Answer 7

Advised to present urgently if they develop pre-eclampsia symptoms (MAC)
(Symptoms are an indication of severe disease)
If <34 wks = early onset pre-eclampsia (15%)

Symptoms:
Headache
Visual disturbances
Oedema (facial and peripheral)
Abdominal pain (upper abdo/ epigastric)
Vomiting

Signs:
Altered mental status
Dyspnoea
Clonus
Oedema

Question 8

Diagnosing pre-eclampsia

Answer 8

HTN >20wks + proteinuria

BP > 140/90
Urine dipstick + cultures
U+Es

Check for HELLP syndrome as well: FBC/ LFT/ Clotting

Question 9

Management of pre-eclampsia

Answer 9

Antihypertensives:
1st - Labetalol
2nd - Nifedapine
3rd - Methyldopa

Monitor BP every 48hrs (more if inpatient) - target 135/85
If BP is >160/110 - admit as inpatient and monitor every 30 mins until <160/110
Blood test bi-weekly - FBC/ UE/ LFT
Fortnightly USS and Foetal heart auscultation

Question 10

Severe pre-eclampsia management

Answer 10

Inpatient
BP - can use multiple drugs
Fluid balance - risk of renal impairment and oedema
Delivery - ?early birth

Question 11

Eclampsia treatment

Answer 11

Obstetric emergency
A-E assessment- focus on maintaining airways and oxygenation
Place pregnant person in left lateral position
Eclamptic seizures - magnesium sulphate
Consider delivery as a definitive management

Question 12

Complications of pre-eclampsia

Answer 12

Eclampsia
HELLP syndrome
DIC

Question 13

HELLP syndrome

Answer 13

Haemolysis, Elevated Liver enzymes, Low Platelets

Question 14

DIC

Answer 14

Disseminated intravascular coagulation
Wide-spread activation of clotting factors -> vast micro-thrombi formation + consumption of clotting factors -> haemorrhage and occlusion of small vessels -> multi-organ failure and death

Life-threatening - can lead to haemorrhage and multi-organ failure