pre-eclampsia
| Headline | |
|---|---|
| Etiology | ↓ spiral artery formation → ↑ uterine spiral artery resistance → compensatory ↑BP. >20/40 else likely pre-existing. |
| Epidemiology | Risk factors: hypertension in prev. pregnancy, CKD, autoimmune disease, diabetes, chronic hypertension, new sexual partner/first child |
| Clinical presentation | headache, blurry vision, RUQ pain, proteinuria No proteinuria = pregnancy induced hypertension |
| Pathogenesis | |
| Diagnostic investigations | |
| Management | Aspirin 75-120mg from week 12 ➥ Proteinuria: screen with dipstick ⇒ quantify with ACR/PCR ➥ Avoid ACE-i/ARBs: ↑ risk congenital renal abnormalities ➥ Target SBP < 140 Target ≤135/85??? ➥ BP control: 1st line = labetalol 100-200mg; 2nd line = nifedipine; 3rd line = methyl-dopa ➥ ⚠ ↑ BP with oxytocin/ergometrine during labour ➥ Complications: progression to eclampsia (https://smolmedic.github.io/#Eclampsia); oligohydramnios, intracranial haemorrhage |
Common risk factors for preeclampsia: (RR = relative risk)(32487899)
- History of preeclampsia (RR ~7; risk of recurrence is ~20%).
- Chronic hypertension (incidence of ~20%).(Vincent 2023)
- Diabetes (RR ~3.5); Renal disease.
- Body mass index >35 (RR ~1.5).
- Thrombophilia; lupus; antiphospholipid antibody syndrome (RR ~10).
- Age >40 (RR ~1.7).
- Multifetal pregnancy (RR ~3); first pregnancy (RR ~2.9).
copied shamelessly from IBCC