pre-eclampsia case questions

• 37 year old lady, pregnant with her first baby.

  BMI is 41.

  PMH: normally fit and well.

  DH: none, no known drug allergies.

  FH: mum has hypertension.

  SH: lives with partner, non-smoker, no alcohol intake, no recreational drugs, works as an accountant.

  does she need aspirin prophylaxis? what else does she need?

  YES - first pregnancy and BMI>30

  • High dose folic acid until 12/40 (due to BMI)
  • Glucose tolerance test at 24-28/40 (due to BMI)
  • Growth scans from 28 weeks (due to BMI)
• what is a foetal growth scan, what is worrying?

  Growth plotted serially on growth chart

  Either measured by fundal height measurement (measuring height of top of uterus) or by estimating weight of baby using a growth scan

  Growth should stay on same centile (dropping/plateauing is concerning – growth restriction)

  
• patient comes in with:

  She has been feeling unwell with a headache recently, and she has also noticed that her legs have got more swollen.

  Growth scan shows: 

  •Estimated fetal weight (EFW) <10th centile (growth restriction)

  •Normal amniotic fluid index (AFI)

  •Normal doppler

  what do you check/test and suspect is the dx?

  check - BP (shown as more than 140/90), urinalysis (3+ protein)

  dx= pre-eclampsia
• which Ix should be done?

  urine PCR = Protein:creatinine ratio raised in pre-eclampsia – more than 30

  FBC – check for low platelets

  U+E – can get raised creatinine, AKI

  LFT – can be deranged

  Uric acid – can be high in severe PET (decreased uric acid clearance due to reduced eGFR = higher serum uric acid)
• your patients hypertension is worsening, what do you think the dx is?

  •Her haemoglobin has decreased to 98

  •Her platelets have decreased to 91

  •Her creatinine has increased to 122

  •Her ALT has increased to 159

  HELLP

  see haemolysis from decreased Hb, see elevated liver enzymes from ALT, low platelets too
• what should you do when you are sure your patient has pre-eclampsia?

  • switch from oral to IV labetalol to control blood pressure
  • IV magnesium sulphate to prevent eclampsia
  • Expedite the delivery (the only cure of pre-eclampsia is delivery of placenta)
• summary of pre-eclampsia

  here

  
• Part of the diagnostic criteria for pre-eclampsia is having a blood pressure of over:

  140/90

  150/110

  140/100

  150/100

  140/90
• maternal and fetal circulation are mixed or seperate?

  separate
• If a pregnant woman is identified as being at high risk of developing pre-eclampsia, aspirin is recommended from

  12 weeks or 16 weeks

  12 weeks
• pre-eclampsia is linked with poor dilation of which artery?

  spiral artery
• which of these increases the risk for pre-eclampsia? asthma or diabetes

  diabetes
• which of the two are RAISED in pre-eclampsia? platelets or uric acid?

  uric acid
• which medication is used to tx seizures in pre-eclampsia ?

  Magnesium sulphate
• true or false: Having swollen legs during pregnancy means you have most likely got pre-eclampsia?

  false
• Which of these is NOT a risk factor for pre-eclampsia:

  first pregnancy

  multiple pregnancy

  maternal age over 40

  family Hx of hypertension

  FHx of hypertension
• which anti-hypertensive is 1st line in PE?

  labetalol