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Questions and Answers
What defines pre-eclampsia with respect to blood pressure and proteinuria?
What is a common complication associated with severe pre-eclampsia?
Which of the following is considered a risk factor for developing pre-eclampsia?
Which laboratory finding is NOT used in the differentiation between severe and non-severe pre-eclampsia?
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What should be initiated before 16 weeks gestation to reduce the risk of early onset pre-eclampsia?
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What is the primary pathological finding in the kidneys during pre-eclampsia?
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In which type of hypertension does pre-eclampsia occur as a secondary condition?
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Which factor is NOT predictive of pre-eclampsia at 11-14 weeks?
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Study Notes
Pre-eclampsia and Eclampsia Overview
- Pre-eclampsia characterized by hypertension (BP > 140/90 mmHg) and proteinuria after 20 weeks of gestation.
- Eclampsia is defined as the convulsive form of pre-eclampsia.
- Essential hypertension present before or after 20 weeks or persists beyond 12 weeks postpartum indicates potential chronic hypertension.
Definitions and Classifications
- Gestational Hypertension: Hypertension that develops after 20 weeks without proteinuria.
- Chronic Hypertension: High blood pressure existing pre-pregnancy or before 20 weeks.
- Pre-eclampsia superimposed on chronic hypertension: Chronic hypertension complicated by new-onset pre-eclampsia features.
Diagnosis Criteria for Pre-eclampsia
- Blood pressure ≥ 140/90 mmHg with proteinuria (≥ 1+ on dipstick, > 300 mg/24h, or protein/creatinine ratio > 0.3).
- Significant changes in blood pressure can be identified postpartum.
Etiology and Pathophysiology
- The second wave of spiral vessel remodeling is often insufficient in women with pre-eclampsia, leading to high-resistance uterine arteries and reduced blood flow.
Prediction of Preeclampsia
- Assessment performed at 11-14 weeks gestation:
- History of antiphospholipid antibodies (APLA), previous pre-eclampsia, chronic hypertension, and overt fetal growth restriction (FGR) are significant risk factors.
- Mean arterial pressure > 100 mmHg and increased mean uterine artery Pulsatility Index (PI) (> 1) are predictive.
- Decrease in biochemical markers such as PIGF, PAPP-A, and VEGF indicates risk.
Prevention Strategies
- Low-dose aspirin (75 - 150 mg daily) initiated before 16 weeks reduces the risk of early onset pre-eclampsia.
Types of Pre-eclampsia
- Classified as severe and non-severe (formerly termed mild).
- The differentiation does not rely on the quantification of proteinuria.
Clinical Features
- Severely elevated blood pressure presents with symptoms like headache, oliguria, and convulsions.
- Laboratory findings:
- Normal creatinine in non-severe, elevated in severe cases.
- Thrombocytopenia and elevated ALT in severe pre-eclampsia.
- Glomerular endotheliosis observed upon examination of the kidney.
Complications
- Maternal risks include eclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count), pulmonary edema, acute renal failure (ARF), disseminated intravascular coagulation (DIC), and posterior reversible encephalopathy syndrome (PRES).
- Fetal risks encompass growth restriction, intrauterine demise, and iatrogenic prematurity.
- Placental risks include abruption placentae.
Management Strategies
- Definitive treatment for pre-eclampsia is delivery.
- Mild pre-eclampsia: Recommend delivery at 37 weeks.
- Severe pre-eclampsia requires admission, prevention protocols, and prophylactic magnesium sulfate to prevent eclampsia.
- Initiate antihypertensives and consider delivery at 34 weeks or earlier based on maternal conditions.
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Description
This quiz covers the critical aspects of pre-eclampsia and eclampsia, including definitions, classifications, diagnosis criteria, and etiology. Understand the differences between gestational and chronic hypertension and the implications of these conditions during pregnancy. Enhance your knowledge on this important maternal health topic.
