preeclampsia

MCQ:

Pre-eclampsia

1. define as development of hypertension after 20 weeks of gestationT
2. common in smokersF
3. asso. with lack of trophoblastic infiltration of arteries wallsT
4. progress to eclampsia less often when antihypertensive treatmentT
5. asso. with increase risk of abruptioT

Notes: 


pre-eclampsia is defines as hypertension of at least
140/90 mmHg recorded on two separate occasions
at least 4 hours apart and in the presence of at least
300 mg protein in a 24-hour collection of urine,
arising de novo after the 20th week of gestation in
a previously normotensive women and resolving
completely by the sixth postpartum week.



Symptoms of pre-eclampsia
• May be asymptomatic
• Headache
• Visual disturbances
• Epigastric and right upper abdominal pain



Signs of pre-eclampsia
• Elevation of blood pressure
• Fluid retention (non-dependent oedema)
• Brisk reflexes
• Ankle clonus (more than three beats)
• Uterus and fetus may feel small for gestational age



Risk factors for pre-eclampsia
Predisposing factors for the development of pre-eclampsia
include:
• conditions in which the placenta in enlarged (multiple
gestation, diabetes, hydrops)
• pre-existing hypertension or renal disease
• pre-existing vascular disease (such as in diabetes or
autoimmune vasculitis)



Organ-specific changes associated with
pre-eclampsia
Cardiovascular
• Generalized vasospasm
• Increased peripheral resistance
• Reduced central venous/pulmonary wedge pressures
Haematological
• Platelet activation and depletion
• Coagulopathy
• Decreased plasma volume
• I ncreased blood viscosity
Renal
• Proteinuria
• Decreased glomerular filtration rate
• Decreased urate excretion
Hepatic
• Periportal necrosis
• Subcapsular haematoma
Central nervous system
• Cerebral oedema
• Cerebral haemorrhages



Investigations for pre-eclampsia
These investigations will be repeated at intervals
depending on the overall clinical picture.
• Urinalysis by dipstick (quantitatively inaccurate).
• 24-hour urine collection (total protein and creatinine
clearance) .
• Full blood count (platelets and haematocrit) .

Blood chemistry (renal function, protein
concentration).
• Plasma urate concentration.
• Liver function.
• Coagulation profile.
Ultrasound assessment:
- fetal size
- amniotic fluid volume
- maternal and fetal
- Dopplers.



Management and treatment
The mainstay of treatment for pre-eclampsia remains
ending the pregnancy by delivering the fetus (and the
placenta).



The principles of management of pre-eclampsia are:
• early recognition of the symptomless syndrome,
• awareness of the serious nature of the condition in
its severest form,.
• adherence to agreed guidelines for admission to
hospital, investigation and the use of
antihypertensive and anticonvulsant therapy,
• well-timed delivery to pre-empt serious maternal
or fetal complications,
• postnatal follow-up and counselling for future
pregnancies.



The aim of antihypertensive therapy is to lower the
blood pressure and reduce the risk of maternal cerebrovascular
accident without reducing uterine blood
flow and compromising the fetus.




drugs 

Labetolol is an alpha-blocking

and beta-blocking agent.

It can be given orally or intravenously

and has a good safety record in pregnancy.

Methyldopa is a centrally acting antihypertensive agent.

It, too, has a long-established safety record in pregnancy,

but can only be given orally and takes upwards

of 24 hours to take effect.

Nifedipine is a calciumchannel

blocker with a rapid onset of action.

It can,

however, cause severe headache that may mimic worsening

disease.

In severe cases of fulminating disease, an intravenous

infusion of hydralazine or labetolol can be titrated

rapidly against changes in the blood pressure.

The drug of choice for the treatment of eclampsia is magnesium

sulphate. This is given intravenously and has

been shown to reduce the incidence of further convulsions

in women with eclampsia.