Pre-eclampsia
Definition
>=140/90 on 2 occasions, 4 hours apart
Subtypes
Gestational Hypertension
>40/90 after 20 weeks
Normalises by 3 months post partum
No prior history hypertension
Chronic Hypertension
>140/90 before 20 weeks gestation and persisting >3 months post partum
Includes essential hypertension, white coat and secondary hypertension
Superimposed Pre-Eclampsia
Chronic hypertension + PE
Pre-Clampsia / Eclampsia
Pre-Eclampsia
Elevated Blood Pressure as per gestational hypertension plus one or more of the following:
Renal Involvement
Proteinuria
Serum Creatitine >90
Oliguria (<0.5mL / kg for 3 consecutive hours)
Haematological Involvement
Thrombocytopenia (>30% reduction in baseline)
Haemolysis
Hepatic Involvement
Elevated AST / ALT
Severe epigastric or RUQ pain
Neurological Involvement
Convulsions
Hyperreflexia with sustained clonus
Severe headache
Photopsia and visual disturbance
Stroke
Pulmonary Oedema
Fetal Growth Restriction
Placental Abruption
Pathogenesis
Stage 1: Failure of invasion of trophoblasts and inadequate remodelling of the uterine spiral arteries
Stage 2: Placental dysfunction
Risk Factors
Short duration of cohabitation
Barrier methods of contraception
New partner
IVF
Interpregnancy interval of >10 years
Obstetric Lupus Syndrome
Thrombophillias
Physical Examination:
Initial assessment BP both arms
Apex beat and heart rate, Flow murmurs
Radiofemoral delay
Renal artery stenosis murmur
Urinalysis
SLE features
Cushing's features
Fundoscopy
Investigations
UEC and Baseline creatinine concentration
TFT
CMP to exlcude PTH disorders
Platelets
LFT
Management
Hypertension
Relative rest - decrease stressors, exercise, work committments
Hospital admission if:
BP not controlled
Biochemistry if abnormal
Symptoms
Fetal compromise
First line beta blocker or central agent
Labetalol 100mg BD/TDS
Methyldopa 250mg TDS/QID
Second line is vasodilator
Hydralazine 12.5mg QID
Third line (addition of beta blocker and central agent)
Anticonvulsant medication if high risk
Magnesium Sulfate
Source
http://www.australiandoctor.com.au/cmspages/getfile.aspx?guid=9dfd16d4-12dc-47a5-97f7-b3631ea96945