QuestionSBA
QuestionChoice
Eclampsia is the presence of tonic-clonic seizures on a background of pre-eclampsia (new-onset, persistent hypertension with either proteinuria or evidence of systemic involvement). This woman has signs and symptoms of pre-eclampsia but has not reported any seizures.
49973
b
Eclampsia
QuestionChoice
Eclampsia is the presence of tonic-clonic seizures on a background of pre-eclampsia (new-onset, persistent hypertension with either proteinuria or evidence of systemic involvement). This woman has signs and symptoms of pre-eclampsia but has not reported any seizures.
49975
d
Gestational hypertension
QuestionChoice
HELLP syndrome is a subtype of severe pre-eclampsia characterised by haemolysis (H), elevated liver enzymes (EL), and low platelets (LP). This woman does not have any evidence of HELLP syndrome.
49974
c
HELLP syndrome
QuestionChoice
Pre-eclampsia is defined as new-onset, persistent hypertension with either proteinuria or evidence of systemic involvement. A frontal headache, peripheral oedema and hyperreflexia are other clinical signs.
49972
a
Pre-eclampsia
QuestionChoice
Whilst labour may result in a slight increase in blood pressure and heart rate; this is not usually associated with proteinuria or other symptoms such as headache, peripheral oedema or brisk reflexes.
49976
e
First stage of labour
Concept
Chapter
# Summary

Pre-eclampsia is a placental condition that often affects pregnant women from around 20 weeks of gestation, characterised by hypertension and proteinuria. Other symptoms include peripheral oedema, severe headache, drowsiness, visual disturbances, epigastric pain, nausea/vomiting and hyperreflexia. The exact aetiology is not entirely understood, but it may be due to dysfunctional trophoblast invasion of the spiral arterioles. Key investigations include blood pressure and urine protein measurements. Management strategies include anti-hypertensive treatment, with labetalol as the first-line agent. Magnesium sulphate is used to prevent and treat eclamptic seizures, but the ultimate curative treatment is delivery of the placenta.

# Epidemiology



Pre-eclampsia affects a significant percentage of pregnancies worldwide, although the exact number varies significantly between different populations and healthcare settings. Risk factors include nulliparity, a previous history or family history of pre-eclampsia, increasing maternal age, pre-existing diseases such as hypertension, diabetes, renal disease, autoimmune disease, obesity, and multiple pregnancies.


# Aetiology



The exact aetiology of pre-eclampsia remains unclear. However, it's believed to be related to dysfunctional trophoblast invasion of the spiral arterioles, which results in decreased uteroplacental blood flow and subsequent endothelial cell damage.


# Signs and Symptoms


Pre-eclampsia is characterised by:

- Hypertension
- Proteinuria
- Peripheral oedema
- Severe headache
- Drowsiness
- Visual disturbances
- Epigastric pain
- Nausea/vomiting
- Hyperreflexia

# Maternal complications

- Eclampsia (seizures due to cerebrovascular vasospasm)
- Organ failure
- Disseminated intravascular coagulation (DIC)
- HELLP syndrome (the presence of haemolysis (H), elevated liver enzymes (EL) and low platelets (LP))

# Foetal complications

- Intrauterine growth restriction
- Pre-term delivery
- Placental abruption
- Neonatal hypoxia


# Differential Diagnosis


The differential diagnosis for pre-eclampsia includes other conditions that can present with hypertensive disorders in pregnancy, such as chronic hypertension, gestational hypertension, and HELLP syndrome. Key signs and symptoms for these conditions include persistent high blood pressure, proteinuria, and various combinations of haemolysis, elevated liver enzymes, and low platelet levels.

# Investigations


Key investigations for pre-eclampsia include:

- Blood pressure measurement: To confirm hypertension.
- Urinalysis: To confirm proteinuria.
- Blood tests: To assess kidney function, liver function, and clotting status.

# Management

Aspirin is used for prophylaxis against the development of pre-eclampsia. It is given from 12 weeks gestation until birth to women with one high risk factor or two (or more) moderate risk factors. 

Management of pre-eclampsia primarily involves anti-hypertensive treatment, with labetalol being the recommended first-line agent. Other agents that can be used include Nifedipine, Methyldopa and hydralazine. 

Magnesium sulphate can be administered for the prevention and treatment of eclamptic seizures. 

The only definitive curative treatment is the delivery of the placenta. It is also crucial to monitor the mother and foetus closely for complications.

97
97
Pre-eclampsia
Topic
38
Obstetrics
Video
Concept
97
Pre-eclampsia
645
8rxWyrL
images/videos/obstetrics.png
Hypertension without proteinuria in pregnancy
Video
Concept
97
Pre-eclampsia
642
bjWyPRB
images/videos/endocrinology.png
Quesmed Tutorial: Obstetrics 2
Video
Concept
97
Pre-eclampsia
620
eriRASf
images/videos/gynecology.png
Quesmed Tutorial: Obstetric Emergencies
Pre-eclampsia
10031
A 40-year-old primigravida at 38+2 weeks gestation presents with a headache unrelieved by analgesia. She has no significant past medical history. On examination, her abdomen is soft and non-tender, with slight ankle swelling and brisk reflexes.



Her observations are as follows:



  - Heart rate: 92 beats per minute
  - Blood pressure: 168/101mmHg
  - Respiratory rate: 20 breaths per minute
  - SpO2: 99% on room air
  - Temperature 36.7°C



CTG is reassuring.



Her full blood count tests are as follows:


||||
|--------------|:-------:|---------------|
|Haemoglobin|129 g/L|(M) 130 - 170, (F) 115 - 155|
|White Cell Count|5.5x10<sup>9</sup>/L|3.0 - 10.0|
|Platelets|385x10<sup>9</sup>/L|150 - 400|






Her liver function tests are as follows:





||||
|---------------------------|:-------:|--------------------|
|Albumin|35 g/L|35 - 50|
|Alanine Aminotransferase (ALT)|40 IU/L|10 - 50|
|Aspartate Aminotransferase (AST)|32 IU/L|10 - 40|
|Alkaline Phosphatase (ALP)|103 IU/L|25 - 115|
|Bilirubin|14 µmol/L|< 17|
|Gamma Glutamyl Transferase (GGT)|20 U/L|9 - 40|
|Lactate Dehydrogenase|168 IU/L|70 - 250 



Urinalysis is positive for protein +++ and is otherwise negative.



What is the most likely diagnosis?
a