Pre-Eclampsia
Definition
Gestational HTN = HTN (>140/90 or >20/15 increase) that arises >20/40 without other features of pre-eclampsia, resolved 3mo after delivery.
Pre-eclampsia = Gestation HTN + any one of:
Epidemiology
Eclampsia 1/2000
Risk Factors
Aetiology
Unknown, possibly genetic
Pathogenesis
Impaired invasion of maternal spiral a by trophoblasts --> spiral a high resistance --> impaired placenta function --> dec secretion of vasodilators --> systemic HTN
Clinical Features
As per "Definition"
Investigation
Bedside: Spot ACR
Bloods: FBC (platelets), LDH, Uric acid, UEC, LFT (HELLP)
Others: CTG
Management
Prevention: Prophylatic aspirin, Ca supplementation (lack of Ca2+ may result in no dip in mid pregnancy BP)
Rx
Moderate:
Severe:
LUSCS if worsen/ close to term
Complications
HELLP syndrome
Source
Llewellyn-Jones. 9th Ed 2010
Gestational HTN = HTN (>140/90 or >20/15 increase) that arises >20/40 without other features of pre-eclampsia, resolved 3mo after delivery.
Pre-eclampsia = Gestation HTN + any one of:
- Neuro (convulsions (eclampsia), UMN signs)
- Liver failure
- Renal Failure
- Proteinuria (>300mg/d or >30mg/mmol)
- Haematological (dec platelets, DIC, haemolysis)
- IUGR
Epidemiology
Eclampsia 1/2000
Risk Factors
- Essential HTN
- T1DM
- Previous pre-eclampsia
Aetiology
Unknown, possibly genetic
Pathogenesis
Impaired invasion of maternal spiral a by trophoblasts --> spiral a high resistance --> impaired placenta function --> dec secretion of vasodilators --> systemic HTN
Clinical Features
As per "Definition"
Investigation
Bedside: Spot ACR
Bloods: FBC (platelets), LDH, Uric acid, UEC, LFT (HELLP)
Others: CTG
Management
Prevention: Prophylatic aspirin, Ca supplementation (lack of Ca2+ may result in no dip in mid pregnancy BP)
Rx
Moderate:
- Admit
- Control BP (Methyldopa/ Labetalol/ Atenolol/ Oxprenolol/ Nifidepine)
- Monitor BP, urine, fluid in/out
Severe:
- Admit
- Control BP (Hydralazine)
- Prevent eclampsia (MgSO4)
- Steroid load
LUSCS if worsen/ close to term
Complications
HELLP syndrome
Source
Llewellyn-Jones. 9th Ed 2010