Pre-Eclampsia (PET)

Question 1

What does PET (in repro terms) stand for?

Answer 1

Pre-eclamptic Toxaemia

Question 2

What is pre-eclampsia? [General Definition]

Answer 2

NEW hypertension
AFTER 20 weeks gestation
in association with SIGNIFICANT PROTEINURIA,

Question 3

What is the diagnostic definition of Pre-Eclampsia?

Answer 3

• Mild hypertension during pregnancy on two occasions more than 4 hours apart.
  OR
• Moderate to Severe Hypertension

AND
Proteinuria >300 mgms per 24 hours.

Question 4

What blood pressure suggests hypertension?

Answer 4

Over

130/80

Question 5

What are some physiological risk factors of pre-eclampsia? (6)

Answer 5

• First pregnancy
• History of Hypertension
• History of Renal Disease
• History of Diabetes
• History of pre-eclampsia
• High BMI (>35)

Question 6

What are some risk factors for pre-eclampsia that can be illicited from history? (4)

Answer 6

• Multigravida
• Family History of pre-eclampsia.
• Very young or very old
• Over 10 years since last pregnancy

Question 7

What is the main fetal complication assocaited with pre-eclampsia?

Answer 7

Impaired placental perfusion.

Question 8

What are some maternal complications associated with pre-eclampsia? (7)

Answer 8

• Eclampsia (seizures)
• Pulmonary Oedema
• HELLP
• Renal Failure
• Cardiac failure
• Stroke
• DIC (disseminated intravascular coagulation)

Question 9

What does HELLP stand for?

Answer 9

Haemolysis
Elevated Liver-enzymes
Low Platelets

Question 10

Are all women symptomatic for pre-eclampsia?

Answer 10

No!

Most women are actually asymptomatic.

Question 11

What are the symptoms of pre-eclampsia? (Think CHEERSS PVPV)

Answer 11

Clonus
Headache
ECLAMPTIC CONVULSIONS
Epigastric pain and tenderness
Reduced urine output
Swelling (suddenly)
Severe Hypertension (& +++ proteinuria)

Papillodema
Vision Blurring
Pain below ribs
Vomiting

Question 12

What biochemical abnormalities do we expect to see in pre-eclamptic women?

Answer 12

↑ Liver Enzyme
↑ Bilirubin
↑ Urea
↑ Creatinine
↑ Urate

Question 13

What haematological abnormalities do we expect to see in pre-eclamptic women>

Answer 13

↓ Platelet
↓ Hg

Signs of Haemolysis (jaundice?)
Features of DIC

Question 14

What is the only CURE for Pre-Eclampsia?

Answer 14

Delivery of Baby AND Placenta

Question 15

What conservative treatment options are available for pre-eclampsia? (4)

Answer 15

• Antihypertensives
• Close observations
• Steroids for fetal lung maturity (only if <36 weeks)
• Consider induction of labour if maternal or fetal condition deteriorates at any time!!

Question 16

How do we manage Eclampsia (basically seizures)?

Answer 16

• • Magnesium Sulphate Bolus *
• Control blood pressure
• Take care to avoid fluid overload.

Question 17

What fluid intake rate should we aim for to avoid fluid overload in pregnant women?

Answer 17

80ml/hour

Question 18

What IV drugs can we use to control blood pressure in ECLAMPTIC women?

Answer 18

• IV LABETOLOL
• IV Hydrallazine

(used if BP > 160/110)

Question 19

What are 3 anti-hypertensives used in the conservative management of pre-eclampsia?

Answer 19

• Labetolol
• Methyldopa
• Nifedipine