1. Pre-eclampsia
Matthew Beaumont

2. Pre- eclampsia Hypertensive disorder of pregnancy Placental origin
Only cure = delivery
Eclampsia (G.sudden occurrence): epileptiform seizures

3. Diagnosis Proteinuria >0.3g/24h AND HTN >140/90mmHG (after 20w)
PREeclampsia
P= proteinuria
R= rising blood pressure
E= oedema

4. Severity Course: Spectrum: Grades:
progressive but variable + unpredictable
Spectrum:
life threatening at 24w to mild HTN at term
Grades:
Mild
Moderate
Severe

5. Pathophysiology Stage 1: Development of disease <20w Asymptomatic
Incomplete invasion of the trophoblast (into spiral arterioles)
Atheromatous lesions
Decreased uteroplacental blood flow

6. Pathophysiology 2 Stage 2: Manifestation of disease
Ischaemic placenta → exaggerated immune response → widespread endothelial cell damage
Vasoconstriction
Increased vascular permeability
Clotting dysfunction

7. Manifestation of disease
Increased vascular resistance= Hypertension
Increased vascular permeability= proteinuria
Reduced placental blood flow= IUGR
Reduced cerebral perfusion= eclampsia

8. Epidemiology: 5% pregnancies
Predisposing factors: Mnemonic:
Nulliparity New
Previous history pre-eclamptics
Obesity often
Family history forget
Older maternal age old
Diabetes diabetics
Autoimmune disease (anti-phospholipid) always
Hypertension Pre-existing (x6) have
Big gap between pregnancies big
Twins (Large placentas) twins
High risk: Low dose aspirin (75mg) from w12

9. Clinical features Asymptomatic (until late) Headache Drowsiness
Visual disturbance
Nausea+ Vomiting
Epigastric pain
Oedema (massive/sudden onset) –feet/ankles/face and hands
Learning aid: Pre-eclampsia dance- work top to bottom

10. Complications Fetal IUGR Stillbirth Pre-term birth Placental abruption
Maternal
Eclampsia (grand mal seizure)- 0.05% UK
Cerebrovascular haemorrhage
HELLP syndrome
Renal failure
Pulmonary oedema
Fetal
IUGR
Stillbirth
Pre-term birth
Placental abruption
Hypoxia

11. HELLP syndrome H (haemolysis) – Dark urine, raised LDH, anaemia
EL (elevated liver enzymes)- Epigastric pain, liver failure, abnormal clotting
LP (low platelets)

12. Investigations Diagnosis: Bloods: Fetal: Screening:
Bedside dipstick urinalysis (1+/2+ quantify)
24hurine collection: 0.3g/24h.
Protein:creatinine ratio: 30mg/nmol
Bloods:
Hb, LFTs, platelets, lactate, U+E
Fetal:
USS (growth)
CTG
Umbilical artery doppler (if abnormal CTG)
Screening:
regular BP + urinalysis checks

13. Management Admit: HTN + Proteinuria, symptoms Drugs:
Nifedipine p.o. + Labetalol i.v.
Magnesium sulphate i.v.- prevent eclampsia (toxicity)
Steroids- fetal lung maturity

14. Delivery Only cured by delivery
Weigh risk disease complications Vs benefits of increasing fetal maturity
Complications/severe= indication for delivery (whatever the gestation)
Complications commonly occur after delivery (24h postpartum)