Pre-eclampsia & Eclampsia

Question 1

Define Pre-eclampsia

Answer 1

new-onset hypertension (≥140/90 mmHg) after 20 weeks of pregnancy, with one or more of the following:

1. Proteinuria (urine protein:creatinine ratio ≥30 mg/mmol or dipstick ≥2+).
2. Maternal organ dysfunction:
   - Renal: Serum creatinine ≥90 µmol/L.
   - Hepatic: Alanine transaminase (ALT) ≥70 IU/L or right upper quadrant pain.
   - Hematological: Platelets < 150,000/µL or hemolysis.
   - Neurological: Severe headache, visual disturbances, or eclampsia (seizures).

Question 2

Pre-eclampsia diagnostic criteria

Answer 2

• Mild: 140/90–159/109 mmHg.
• Severe: ≥160/110 mmHg.

Question 3

what anti-hypertensive should be avoided in pre-eclampsia and why

Answer 3

ACE-i / ARBs - teratogenic

Question 4

Pre-eclampsia prophylaxis medication

Answer 4

Aspirin 75-150mg

Question 5

when should Aspirin prophylaxis Tx start

Answer 5

from 12 wks until birth

Question 6

who should receive aspirin prophylaxis

Answer 6

• existing HTN
• DM
• autoimmune
• Hx of pre-eclampsia
• Multifetal
• BMI >35

Question 7

Pre-eclampsia 1st line Tx

Answer 7

1. Labetalol oral / IV
2. Nifidipine m/r
3. Methyldopa

Question 8

what is used for seizure (eclampsia) prophylaxis in pre-eclampsia

Answer 8

Mg sulphate IV

Question 9

Pre-eclampsia Sx

Answer 9

• Severe headache
• Oedema (peripheral oedeam)
• Vision problem (papilloedema)
• Vomiting

Question 10

Pre-eclampsia Risk factors

Answer 10

• Hx of HTN, pre-eclampsia, eclampsia during preg
• Existing renal insuff
• Autoimm disease (SLE, antiphospholipid syndrome)
• Maternal BMI ≥ 35 at initial presentation
• Multiple pregnancy
• Diabetes Mellitus

Question 11

Pre-eclampsia Dx Ix

Answer 11

• Urinalysis
• Urine ACR
• BP

Question 12

Definitive solution for pre-eclampsia

Answer 12

Delivering the baby

Question 13

Pre-eclampsia complications

Answer 13

• HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome
• Eclampsia

Question 14

Define Eclampsia

Answer 14

the occurrence of one or more seizures (fits) in a woman with pre-eclampsia that cannot be attributed to other causes.

Question 15

Eclampsia Sx

Answer 15

• Prodrome: severe headache, visual disturbances, epigastric pain, and altered mental status
• generalised tonic-clonic

Question 16

At what BP should women with Pre-eclampsia be admitted

Answer 16

> 160/110

Question 17

Pre eclampsia Urine PCR criteria

Answer 17

≥30 mg/mmol

Question 18

Describe the seizure in eclampsia

Answer 18

• new onset tonic-clonic seizure (in the presence of pre-eclampsia)
• lasting around 60 to 75 seconds
• followed by a variable lasting post-ictal phase (confusion etc)

Question 19

What is the first condition to exclude in patients having seizures?

Answer 19

Hypoglycaemia

Question 20

Investigations in suspected eclampsia

Answer 20

FBC: ↓ Hb, ↓ platelets (HELLP)
U&Es: ↑ urea, ↑ creatinine, ↑ urate, ↓ urine output (renal func. UO)
LFTs: ↑ ALT, ↑ AST, ↑ bilirubin. (HELLP)
Clotting studies (DIC)
Blood glucose (hypoglycaemia)

Question 21

Eclampsia stepwise Mx

Answer 21

1. Resuscitation: ABCDE, L lat. position w/ airways + O2
2. Cessation of Seizures: MgSO4
3. BP control: labetalol and hydralazine - MAP < 120 mmHg
4. Prompt Delivery of Baby and Placenta: C-section only when mother is table
5. Monitoring: Fluid balance for pulmonary oedema / AKI

Question 22

Eclampsia post-natal inpatient F/U

Answer 22

Regular symptom review – e.g headaches, epigastric pain.
Bloods 72 hrs post-partum – FBC, LFTs, creatinine.
Pre-conceptual counselling – advice regarding minimising risk factors and prophylaxis for future pregnancies.
Step-down care to community – when reached target BP and asymptomatic

Question 23

Eclampsia post-natal OP F/U

Answer 23

• Consider CT Head – if persistent neurological deficit.
• Measure BP – in the UK, blood pressure is checked daily for 2 weeks post-partum.
• Follow-up at 6 weeks – check BP, proteinuria and creatinine. Repeat FBC, LFTs and creatinine if not previously returned to normal