Pre-eclampsia & Eclampsia

§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