§Pre-eclampsia;
§Pregnancy-induced hypertension >20/40
§Associated proteinuria (>0.3g in 24o or 1+ on dip)
§+/- oedema
§Severe pre-eclampsia;
§Systolic >160mmHg or diastolic >100mmHg
§+/- symptoms or abnormal bloods
§Eclampsia;
§Convulsions on a background of pre-eclampsia
§Symptoms of severe pre-eclampsia;
§Severe frontal headache
§Oedematous face/hands/feet
§Liver tenderness, epigastric pain + vomiting
§Visual disturbance (blurred/flashing lights)
§Falling platelets and rising ALT
§Clonus
§Papilloedema
§Fetal distress, reduced fetal movements + IUGR
§Pathophysiology;
§Insufficient uteroplacental perfusion
§Maternal inflammatory response + vascular endothelial dysfunction
What are the risk factors for pre-eclampsia?
§Risk factors;
§1st pregnancy/1st pregnancy with new partner
§Previous pre-eclampsia
§>10 years since last child
§Aged >40 years
§BMI >35
§FH of pre-eclampsia
§PMH of HTN/DM/renal disease
§Investigations;
§BP profile (3x separate readings)
§Urinalysis, MSU and protein:creatinine ratio
§FBC, U+E, LFTs + serum urate
§Fetal assessment (CTG, growth scan + dopplers)
§If stable and asymptomatic with normal bloods can be managed and monitored at home
§Admit if signs of severe pre-eclampsia
§Initial Management;
§BP 140/90 to 149/99
§Check bloods and monitor BP
§BP150/100 to 159/109
§Start oral labetalol, check bloods and monitor BP
§BP >160/110
§Start oral labetalol, check bloods and admit
If severe pre-eclampsia not controlled on oral labetalol;
§2nd line: oral nifedipine
§3rd line: IV labetalol/hydralazine
§4th line: IV hydralazine
§Plus IV magnesium sulphate for seizure prophylaxis prior to delivery + postnatally
What do we need to do for baby at 34+3?
§Approximately 44% of seizures occur postnatally
§Post-partum care;
§Ongoing BP and fluid balance monitoring
§Continue MgSO4 for at least 24hrs post-delivery
§Continue oral anti-hypertensives on discharge
§Community midwife + GP to monitor BP