Pre-eclampsia

Aetiology/Pathophysiology

100

A woman develops hypertension and proteinuria at 32 weeks' gestation. Which organ is primarily responsible for initiating the pathological process underlying her condition?

Placenta

200

Pre-eclampsia develops after what point in pregnancy?

20 weeks

300

Name 5 risk factors for pre-eclampsia

Nulliparity, previous history, diabetes, multiple pregnancy, molar pregnancy, high BMI, maternal age >40, gestational hypertension, PCOS. 

400

Name 2 biomarkers that can be used to assess risk of or diagnose pre-eclampsia

sFlt-1/PlGF ratio

Soluble fms-like tyrosine kinase-1

Placental growth factor

500

What pathological process actually causes hypertension and clinical manifestations of pre-eclampsia?

Systemic vasoconstriction and capillary leaking. 

Clinical Features

100

What are the BP cutoffs for diagnosing pre-eclampsia?

>140/90

200

How is pre-eclampsia diagnosed?

Elevated BP 

Proteinuria/organ manifestations

300

What are the systemic features that indicate pre-eclamspia?

Thrombocytopenia

Renal insufficiency 

Impaired LFTs

Pulmonary oedema

Headache

400

What is eclampsia?

Pre-eclampsia + seizure

500

What severe complication of pre-eclampsia can manifest as severe upper abdominal pain?

HELLP

Haemolysis, elevated liver enzymes and low platelets. 

Investigations

100

What bedside investigations should be done when pre-eclampsia is suspected?

Urinalysis, BP and CTG

200

What neurological finding is seen in pre-eclampsia?

Hyperreflexia with sustained clonus 

300

Bloods to order when pre-eclampsia is suspected

FBC, LFTs, U+Es and Coag 

Can order sFlt-1/PlGF

400

What investigation is done in pre-eclampsia to assess the effects on the foetus?

Fetal growth measurements and doppler ultrasound

500

How are women screened for pre-eclampsia?

BP checks and urine dipstick at community midwife appointments

Management

100

What medications are given to lower BP in pregnancy?

Labetalol - 1st line

Nifedipine - 2nd line

Methyldopa - third 

200

What is the definitive management of pre-eclampsia?

Delivery of foetus 

300

What drug is used to prevent seizures in eclampsia?

Magnesium sulphate

400

Why might you need to deliver the baby early?

Maternal complications - prevent seizure, HELLP syndrome, pulmonary oedema, abruption

Fetal complications - inc. risk of IUGR, stillbirth,

500

What week of pregnancy is highest risk for eclamptic seizures?

Trick question - first 48 hours postpartum