Preeclampsia resident survival guide

Jump to navigation Jump to search


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.

Synonyms and keywords:

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

The high risk factors of preeclampsia are

Women are at moderate risk if they are

Additional clinical factors:

  • Raised mean arterial blood pressure before 15 weeks’ gestation[3]
  • Polycystic ovarian syndrome[4][5]
  • Sleep disordered breathing [6]
  • Various infections such as periodontal disease, urinary tract infections[7] and helicobacter pylori[8].
  • Vaginal bleeding for at least five days during pregnancy increases preeclampsia risk[3]
  • Use of oocyte donation has a higher risk of preeclampsia than in vitro fertilization (IVF) without oocyte donation or natural conception.[9][10]
Common Causes

Common cause of preeclampsia include uteroplacental ischemia and genetic predisposition due to the following:[11][12]

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Gestational Hypertension.

 
 
 
 
 
 
Pregnant woman with history of Hypertension
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Take complete history
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Take obstetric history :

❑ Date of last menstrual period?

❑ Estimated date of delivery

❑ Confirm the gestational age, gravidity and parity.

❑ Check if this is a single or multiple gestation.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask about previous obstetric history if she was previous pregnant :

❑ Ask about previous pregnancies including miscarriages and terminations.

❑ Length of gestation.

❑ Ask about mode of delivery.

❑ Ask if there was similar complaints during previous pregnancy?

❑ Was there any complications throughout the pregnancy or during delivery such as shoulder dystocia, postpartum haemorrhage ?

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask the following questions about menstrual history :

❑ Age of menarche

❑ Last menstrual period

❑ Is the menstrual flow normal? How many pads she has to use in a day?

❑ Is there any foul smell or colour change?

❑ How many days does the menstruation stay?

Contraceptive history for example oral contraceptives, intrauterine device

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
See if following factors are present:

❑ History of hypertension

Kidney disease

Diabetes

Hypertension with a previous pregnancy

❑ Mother's age younger than 20 or older than 40

❑ Multiple fetuses (twins, triplets)

❑ African-American race

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Do laboratory tests[1]:

Haemoglobin

Platelet count

❑ Serum creatinine

Liver enzymes

❑ Serum uric acid

❑ Use of PlGF or sFlt-1:PlGF ratio to help rule out preeclampsia in women between 20 and 34 + 6 weeks’ gestation in whom preeclampsia is suspected.[13]

❑ Ultrasound assessment of fetal growth and umbilical artery doppler velocimetry or cerebroplacental ratio measurements to assess blood flow redistribution in placental insufficiency.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PRE-ECLAMPSIA:Preeclampsia is defined as Gestational Hypertension associated with new-onset maternal or uteroplacental dysfunction at or after 20 Weeks’ Gestation

❑ Gestational Hypertension : blood pressure higher than 140/90 measured on two separate occasions, more than 6 hours apart.[14]

Accompanied by at ≥1 of the following new-onset conditions[15]:
❑Proteinuria: automated dipstick urinalysis should be done. If not available, visual analysis can be used. If dipstick is positive (≥1+), confirmation is done with spot urine.
Abnormal if Protein:Creatinine ≥ 30 mg/mmol or Albumin:Creatinine ≥ 8 mg/mmol.[16][17]

Renal complication: Acute Kidney Injury (creatinine ≥ 90 umol/L).

Liver complications: Elevated transaminases, may be associated with right upper quadrant of epigastric abdominal pain.

Neurological complications: Eclampsia, altered mental status, blindness, stroke, clonus, severe and persistent visual scotomata.

❑ Haematological complications: Thrombocytopenia (platelet count < 150000/µL, disseminated intravascular coagulation, hemolysis).

Uteroplacental dysfunction: Fetal growth restriction, abnormal umbilical artery doppler wave form analysis, stillbirth.

 
 
 
 
 
 
 
 
 
 
 
 
 
 


Treatment

Shown below is an algorithm summarizing the treatment of mild hypertension and preeclampsia.


 
 
 
 
 
 
 
Woman with mild hypertension and pre eclampsia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Evaluate maternal and fetal condition
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


❑ ≥40 weeks of gestation

❑ ≥ 37 weeks of gestation, Bishop score ≥ 6, non-complaint patient

❑ ≥34 weeks gestation, Labor or rupture of membranes, Abnormal fetal testing, Intrauterine growth restriction

 
Yes
 
Delivery
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
<37 weeks
 
 
 
37-39 weeks
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 



Shown below is an algorithm summarizing the treatment of severe preeclampsia.

 
 
 
 
 
 
 
Woman with severe pre eclampsia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


❑ Admit to labor and delivery unit.

❑ Evaluate maternal and fetal condition for 24 hours.

❑ Administer Magnesium sulphate X 24 hours.

❑ Anti-hypertensives if systolic blood pressure ≥ 160mm Hg, Diastolic ≥110 mmHg and meant retrial blood pressure ≥125 mmHg

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Check if following are present:

---

❑ Maternal distress

❑ Non-reassuring fetal status.

❑ Labor or rupture of membranes.

❑ >34 weeks of gestation.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Magnesium Sulphate

❑ Delivery.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Severe intrauterine growth restriction
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Steroids
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
33-34 weeks of gestation
 
23-32 weeks of gestation
 
<23 weeks of gestation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


❑ Steroids at 24-32 weeks

Anti-hypertensives if required.

❑ Daily maternal and fetal evaluation.

❑ Delivery at 34 weeks.

 
termination of pregnancy
 
 

Do's

  • The content in this section is in bullet points.

Don'ts

  • The content in this section is in bullet points.

References

  1. 1.0 1.1 Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, Hall DR, Warren CE, Adoyi G, Ishaku S (July 2018). "Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice". Hypertension. 72 (1): 24–43. doi:10.1161/HYPERTENSIONAHA.117.10803. PMID 29899139.
  2. "Overview | Hypertension in pregnancy: diagnosis and management | Guidance | NICE".
  3. 3.0 3.1 North RA, McCowan LM, Dekker GA, Poston L, Chan EH, Stewart AW, Black MA, Taylor RS, Walker JJ, Baker PN, Kenny LC (April 2011). "Clinical risk prediction for pre-eclampsia in nulliparous women: development of model in international prospective cohort". BMJ. 342: d1875. doi:10.1136/bmj.d1875. PMC 3072235. PMID 21474517.
  4. Bahri Khomami M, Joham AE, Boyle JA, Piltonen T, Silagy M, Arora C, Misso ML, Teede HJ, Moran LJ (May 2019). "Increased maternal pregnancy complications in polycystic ovary syndrome appear to be independent of obesity-A systematic review, meta-analysis, and meta-regression". Obes Rev. 20 (5): 659–674. doi:10.1111/obr.12829. PMID 30674081.
  5. Qin JZ, Pang LH, Li MJ, Fan XJ, Huang RD, Chen HY (June 2013). "Obstetric complications in women with polycystic ovary syndrome: a systematic review and meta-analysis". Reprod Biol Endocrinol. 11: 56. doi:10.1186/1477-7827-11-56. PMC 3737012. PMID 23800002.
  6. Pamidi S, Pinto LM, Marc I, Benedetti A, Schwartzman K, Kimoff RJ (January 2014). "Maternal sleep-disordered breathing and adverse pregnancy outcomes: a systematic review and metaanalysis". Am J Obstet Gynecol. 210 (1): 52.e1–52.e14. doi:10.1016/j.ajog.2013.07.033. PMID 23911687.
  7. Rustveld LO, Kelsey SF, Sharma R (March 2008). "Association between maternal infections and preeclampsia: a systematic review of epidemiologic studies". Matern Child Health J. 12 (2): 223–42. doi:10.1007/s10995-007-0224-1. PMID 17577649.
  8. Bellos I, Daskalakis G, Pergialiotis V (February 2018). "Helicobacter pylori infection increases the risk of developing preeclampsia: A meta-analysis of observational studies". Int J Clin Pract. 72 (2). doi:10.1111/ijcp.13064. PMID 29388723.
  9. Blázquez A, García D, Rodríguez A, Vassena R, Figueras F, Vernaeve V (July 2016). "Is oocyte donation a risk factor for preeclampsia? A systematic review and meta-analysis". J Assist Reprod Genet. 33 (7): 855–63. doi:10.1007/s10815-016-0701-9. PMC 4930777. PMID 27007875.
  10. Masoudian P, Nasr A, de Nanassy J, Fung-Kee-Fung K, Bainbridge SA, El Demellawy D (March 2016). "Oocyte donation pregnancies and the risk of preeclampsia or gestational hypertension: a systematic review and metaanalysis". Am J Obstet Gynecol. 214 (3): 328–39. doi:10.1016/j.ajog.2015.11.020. PMID 26627731.
  11. Lye, P.; Bloise, E.; Dunk, C.; Javam, M.; Gibb, W.; Lye, S.J.; Matthews, S.G. (2013). "Effect of oxygen on multidrug resistance in the first trimester human placenta". Placenta. 34 (9): 817–823. doi:10.1016/j.placenta.2013.05.010. ISSN 0143-4004.
  12. Mayrink, J.; Costa, M. L.; Cecatti, J. G. (2018). "Preeclampsia in 2018: Revisiting Concepts, Physiopathology, and Prediction". The Scientific World Journal. 2018: 1–9. doi:10.1155/2018/6268276. ISSN 2356-6140.
  13. Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennström M, Olovsson M, Brennecke SP, Stepan H, Allegranza D, Dilba P, Schoedl M, Hund M, Verlohren S (January 2016). "Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia". N Engl J Med. 374 (1): 13–22. doi:10.1056/NEJMoa1414838. PMID 26735990.
  14. Lo JO, Mission JF, Caughey AB (April 2013). "Hypertensive disease of pregnancy and maternal mortality". Curr Opin Obstet Gynecol. 25 (2): 124–32. doi:10.1097/GCO.0b013e32835e0ef5. PMID 23403779.
  15. Fox R, Kitt J, Leeson P, Aye C, Lewandowski AJ (October 2019). "Preeclampsia: Risk Factors, Diagnosis, Management, and the Cardiovascular Impact on the Offspring". J Clin Med. 8 (10). doi:10.3390/jcm8101625. PMC 6832549 Check |pmc= value (help). PMID 31590294. Vancouver style error: initials (help)
  16. Price CP, Newall RG, Boyd JC (September 2005). "Use of protein:creatinine ratio measurements on random urine samples for prediction of significant proteinuria: a systematic review". Clin Chem. 51 (9): 1577–86. doi:10.1373/clinchem.2005.049742. PMID 16020501.
  17. Kucukgoz Gulec U, Sucu M, Ozgunen FT, Buyukkurt S, Guzel AB, Paydas S (October 2017). "Spot Urine Protein-to-Creatinine Ratio to Predict the Magnitude of 24-Hour Total Proteinuria in Preeclampsia of Varying Severity". J Obstet Gynaecol Can. 39 (10): 854–860. doi:10.1016/j.jogc.2017.04.035. PMID 28647444.


Template:WikiDoc Sources