Pre eclampsia Flashcards
State the definition of pre eclampsia
New onset of hypertension over 20 weeks of pregnancy, and with the coexistence of 1 or more of the following conditions; proteinuria, maternal organ dysfunction, and any utero-placental dysfunction.
What is classed as hypertension?
systolic over 140 diastolic over 90
Name the risk factors for pre eclampsia
primiparity, 10 years since last pregnancy, over 40, ethnicity, BMI over 35, family history, chronic hypertension, diabetes or renal disease.
What causes pre eclampsia?
trophoblasts help form the placenta, if they do not embed in the myometrium, the spiral arteries do not thicken, therefore there is a poor blood supply called poor placentation. Because of the unsuccessful embedding, an inflammatory response is signalled, this causes endotheliums to become leaky, proteins and water leave the vascular system causing oedema across the body, particularly the hands and feet. Vasoconstriction takes place, which means blood pressure is raised.
How are the kidneys affected by this?
they suffer glomelular damage, salt retention, reduced urine supply (oliguria), and proteinuria.
How are they eyes affected?
blurred vision, scotomas (blank spaces in vision), and headaches; all caused by the oedema present.
Why can oedema become very harmful?
if pulmonary oedema occurs, this can restrict the airways.
if cerebral oedema occurs, this causes seizures, and potential risk of strokes.
What are the main risks for the fetus?
fetal growth restriction, perfusion affected, IUD, reduced fetal movements.
List the symptoms of pre eclampsia;
proteinuria, raised blood pressure, oedema, oliguria, blurred vision, frontal headaches, epigastric pain, and shortness of breath.
What causes low platelets in women suffering with pre eclampsia?
Due to vasopermeability, clots called thrombi begin to form in the vascular system. This causes low platelets as they are being used to form the clots. This can then lead to other blood cells to “crash” into the thrombi, and haemolysis of blood cells occurs.
What does HELLP stand for?
haemolysis, elevated liver enzymes, low platelets
How do we manage pre eclampsia during pregnancy?
labetalol for high blood pressure, nifedipine for high blood pressure for women with asthma. Magnesium sulphate to prevent seizure activity. Consider early delivery.
What events may cause early delivery, and when would this be?
Usually be between 37th and 38th week, can be before 37th week if there is a serious risk to yours or your babies health.
severe unresponsive hypertension, deteriorating liver function tests, falling platelets, IUGR, fetal distress.
How much fluid is recommended during labour with women who have pre eclmapsia?
80ml/hr
Would we give women ergometrine and syntometrine for active management of the first stage?
no
