Pre-eclampsia

Question 1

What is pre-eclampsia?

Answer 1

• pre-eclampsia or PET is a major cause of maternal and fetal mortality and morbidity
• it is a pregnancy-specific syndrome characterised by variable degrees of placental dysfunction and a maternal response featuring systemic inflammation and by the development of new hypertension and significant proteinuria in the 2nd half of pregnancy
• occurs in 2-7% of all pregnancies
• pre-eclampsia once established will always progress as long as the pregnancy continues

Question 2

What are the risk factors for PET?

Answer 2

• extremes of maternal age
• primiparity
• chronic hypertension
• family history
• previous pre-eclampsia

Question 3

What are the complications of pre-eclampsia?

Answer 3

• can progress to severe pre-eclampsia and eclampsia
• fetal complications
  —> IUGR
  —> prematurity
  —> placental abruption
  —> intrauterine death
• maternal complications
  —> renal and liver failure
  —> intracerebral bleeds
  —> eclampsia
  —> HELLP syndrome
  —> DIC
  —> liver rupture
  —> death

Question 4

How is it medically managed?

Answer 4

• women indemnified as at risk of developing PET should be referred for specialist input - may involve investigation of current medical problems, normally started on aspirin from 12 wks
• if pre-eclampsia develops
  —> inpatient care is required
  —> BP should be treated with labetalol if >150/100
  —> FBC, U+E, LFT measured 2-3 times per week
  —> USS performed for growth, AFI and umbilical artery Doppler
  —> corticosteroids should be given if <34 wks
  —> consider thromboprohphylaxis with TEDS and low molecular weight heparin
  —> care plan made, including thresholds for delivery

Question 5

What is the role of the midwife antenatally?

Answer 5

• if low risk for pre-eclampsia, BP and proteinuria assessment made at a/n appts
• if proteinuria PCR should be performed
• educate about signs and symptoms of PET and refer to obstetrician if any develop
• psychological support and advice

Question 6

What are the signs and symptoms of pre-eclampsia?

Answer 6

• severe headache
• visual disturbances
• upper epigastric pain
• proteinuria
• hypertension
• nausea or vomiting
• oedema

Question 7

What could be the issues that affect labour?

Answer 7

• corticosteroids given if <34 wks and often between 34 an 36+6 wks if LSCS is expected
• blood tests depending on previous results and clinical picture
• severe PET may prompt delivery
• avoid syntometrine/ergometrine for 3rd stage
• observe BP postnatally
• may require HDU monitoring

Question 8

How should PET be managed postnatally?

Answer 8

• continue antihypertensive medication if started antenatally with reduction once BP <130/80 mmHg
• repeat bloods 48-72 hours after
• review antihypertensive treatment at 2 wks by GP
• obstetric review at 6-8wks

Question 9

What is the midwife’s role postnatally?

Answer 9

• BP check 4 times daily whilst inpatient
• BP check at least once days 3-5
• refer if BP <150/100
• ensure 6-8 wk review

Question 10

What is eclampsia?

Answer 10

• severe pre-eclampsia can lead to eclampsia which is the occurrence of one or more generalised convulsions on the background of pre-eclampsia

Question 11

How should severe pre-eclampsia be managed?

Answer 11

• anti-hypertensives should be used, may be IV
• fluid restriction advised to avoid fluid overload
• intravenous magnesium sulfate should be given to all women with severe pre-eclampsia as it halves risk of an eclampsia
• fluid balance
• continuous fetal monitoring