Signs of of Pre-eclampsia in pregnancy

Definition:

• Pre-eclampsia is a multi system disorder characterised by hypertension and proteinuria. It is difficult to define clinically due to it's heterogeneous nature.
• It is defined as blood pressure of more than 140/90 and more than 300mg/24hr of protein in the urine.
• In women who are hypertensive, a rise of systolic of more than 30mmHg or diastolic of more than 15mmHg is taken.
• Affects 5% to 10% of pregnancies
  

Pathophysiology:

• Believed to be placenta in origin
• Increase vascular resistance : hypertension
• Increase vascular permeability: proteinuria, edema
  
• Decrease placenta blood flow: Intra-uterine growth restriction
• Decrease cerebral perfusion: Eclampsia
• Edothelial cell damage: Clotting abnormality and liver damage

Classification of pre-eclampsia

• Mild - BP <170/110
• Moderate - BP >170/110
• Severe - Pre-eclampsia <32>

Risk factors for pre-eclampsia

• Nulliparous
• Previous pre-eclampsia
• Family history of pre-eclampsia
• Extremes of maternal age
• Large placeneta : eg twin
• Microvascular disease : DM, renal disease, autoimmune disease
• Existing hypertension
• Obesity

Symptoms of Pre-eclampsia

• Central nervous system: Headache, drowsy, visual problems
• Gastro-intenstinal: Nausea, vomting, epogastric pain

Signs of Pre-eclampsia

• Hypertension
• Edema
• Clonus
• Epigastric tenderness

Complications of pre-eclampsia and treatment of problems

• Eclampsia : grand mal seizure - treat with IV magnesium sulphate
  
• Cerebral hemorrhage: Preventing BP of more than 170/110 (belived to prevent loss of autoregulation)
• HELLP: Hemolysis, Elevated Liver enzymes, Low Platelets. - supportive
  
• DIVC (disseminated intra-vascular coagulation)
• Renal failure: May need dialysis
  
• Pulmonary edema: Frusemide, ventilation
• Fetal: IUGR, Placental abruption, fetal hypoxia

Prevention of pre-eclampsia

• Patients with previous severe or early onset pre-eclampsia should be offered low dose aspirin.

Admission criteria for pre-eclampsia

• BP> 160/110
• Any complications
• Once proteinuria 1+ (admit for 24hr UTP)or >300mg/24hr

Management of Pre-eclampsia

• Monitor for complications: Fetal and blood and clinical monitoring
• Control BP: Oral nifedipine and methyldopa (s.e depression, loss of patellar reflex)
• Steroids if gestation <34>
• Delivery (Eclampsia can still happen up to 24hrs post delivery)