Pre eclampsia and Eclampsia

Question 1

Definition of pre eclampsia

Answer 1

1. BP > 140/90
2. > 300 mg of proteinuria
3. within 24 hours
4. After 24 weeks

Question 2

PAPP-A in pre eclampsia

Answer 2

1. Low pregnancy associated plasma protein associated with high risk of pre eclampsia

Question 3

Blood test results in pre eclampsia

Answer 3

1. Raised uric acid
2. Low platelets
3. High Hb
   ( help differentiate pre eclampsia from PIH)
4. Low PAPP-A

Question 4

Ultrasound results indicating pre eclampsia

Answer 4

1. Uterine artery doppler at 11-13 or 22-24 predictive of early onset pre eclampsia
2. Fetal growth restrictions on ultra sound

Question 5

Risk factors for pre eclampsia

Answer 5

1. Previous onset pre eclampsia x 7 risk
2. Age > 40
3. Family history
4. Obesity
5. Multiple pregnancy

Question 6

Pre existing medical conditions which increase risk of pre eclampsia ;

Answer 6

1. Hypertension
2. Renal disease
3. Diabetes
4. Anti phospholipid antibodies
5. Thrombophilia

Question 7

Prevention of pre eclampsia

Answer 7

Women with past medical history of severe early onset pre eclampsia should be offered low dose asprin < 16 weeks to reduce incidence

Question 8

Most common presentation of pre eclampsia

Answer 8

Asymptomatic

Question 9

Symptoms which may occur in severe pre eclampsia

Answer 9

1. Head ache - frontal
2. Visual disturbance
3. Epigastric/RUQ pain
4. N & V
5. Facial oedema

Question 10

Pain in pre eclampsia

Answer 10

1. Frontal headache

2. Epigastric/RUQ pain

Question 11

Cerebral signs of pre eclampsia

Answer 11

1. Hyper reflexia and or clonus > 3 beats is a sign of cerebral irritability
2. Confusion

Question 12

Pre eclampsia increases the risk of

Answer 12

Placental abruption

- uterine tenderness or vaginal bleeding may be seen from a placental abruption

Question 13

FBC results

Answer 13

1. High Hb
2. Thrombocytopenia
3. Anaemia if hemolysis ( HELLP syndrome)

Question 14

Coagulation screening

Answer 14

Prolonged

• prothrombin time
• Activated partial thromboplastin time

Question 15

Biochemistry

Answer 15

1. Increased Urate
2. Increased Urea
3. Abnormal LFTs
4. Lactate dehydrogenase is raised ( marker for haemolysis )
5. Increased proteinuria

Question 16

Severe complications of Pre eclampsia

Answer 16

1. HELLP
2. Cerebral haemorrhage
3. IUGR and fetal compromise
4. Placental abruption

Question 17

When is outpatient management appropriate?

Answer 17

1. BP < 160/<110
2. No or low proteinuria
3. Difficult to distinguish from gestational hpt

Question 18

Out patient management of pre eclampsia

Answer 18

1. Warn about symptom development
2. 1 - 2 week review about BP and urine
3. Weekly review of bloods

Question 19

Mild - moderate pre eclampsia defined as t

Answer 19

BP < 160/<110
Significant proteinuria (>300mg)

Question 20

Management of mild - moderate pre eclampsia

Answer 20

1. Admission
2. 4 hourly BP
3. 24 hour urine collection for protein
4. Daily urinalysis
5. Fetal CTG daily
6. Regular US
7. Regular blood tests

Question 21

Define severe pre eclampsia

Answer 21

BP > 160 / >110 in the presence of significant proteinuria

Question 22

Treatment of severe pre eclampsia

Answer 22

1. Only treatment is full delivery of the placenta

Question 23

Management of severe pre eclampsia

Answer 23

1. BP stabilised with antihypertensives ( < 169/ <110)
2. Per oral Nifedipine or IV labetalol for immediate management
3. Maintainance therapy with Methydopa

Question 24

Eclampsia

Answer 24

Tonic clonic seizures in association with a diagnosis of Pre eclampsia

Question 25

When can Eclampsia occur?

Answer 25

1. Antenatally ( 38%) 2. Intrapartum (20%) 3. Postnatally within 48 hours (44%) 4. May be initial presentation of pre eclampsia, may occur before hpt or proteinuria

Question 26

HELLP syndrome definition

Answer 26

- Serious complication of pre eclampsia - Manifests as; 1. Haemolysis 2. Elevated liver enzymes 3. Low platelets

Question 27

HELLP syndrome

Answer 27

Liver enzymes increase and platelets decrease before hemolysis occurs

Question 28

Symptoms of HELLP syndrome

Answer 28

1. Epigastric or RUQ pain 2. Nausea and vomiting 3. Tea coloured urine due to hemolysis

Question 29

Urine in HELLP syndrome

Answer 29

tea coloured due to hemolysis

Question 30

Signs in HELLP syndrome

Answer 30

1. tenderness in RUQ 2. Increase in BP and other features of pre eclampsia 3. Eclampsia may co exist

Question 31

Management of HELLP syndrome

Answer 31

1. Delivery is indicated 2. Magnesium sulphate indicated 3. Platelet infusion only if there is bleeding or surgery ( not for low levels caused by the syndrome)