Pre-eclampsia

 

Diagnosis:

Definition

·      Hypertension: >140/90 after 20 weeks

·      End-organ dysfunction

o    Placenta: IUGR

o    Kidney: proteinuria >30mg/mmol, ↑creat

o    Liver: ↑transaminases, RUQ pain

o    Haem: ↓plt, haemolysis, DIC

o    Neuro: hyperreflexia, confusion, seizure, stroke

Pathophysiology

·      Abnormal placentation

·      Endothelial funny business

·      Organ dysfunction

 

Pre-eclampsia issues: mother

Resp

·      Airway oedema

·      Pulmonary oedema

CVS

·      ↑SVR

·      LV dysfunction

·      Hypovolaemia

CNS

·      Seizures

·      ICH

Haem

·      HELLP

·      DIC?

Renal

·      ↓function

Hepatic

·      ↓function

·      Capsular haemorrhage

 

Pre-eclampsia issues: baby

Abnormal placentation

·      IUGR

Premature delivery

·      Neurotoxicity

·      Poor thermoregulation (warm)

·      Lung and resp centre immaturity (pink)

·      Poor glycogen storage and feeding (sweet)

 

Goals: mother

Stop the disease

·      Deliver!

·      -If disease severe

·      -If baby cooked (>37/40)

No stroke

·      Antihypertensive. Aim <160/110

·      Avoid GA

·      Alfentanil 20mcg/kg before intubation

·      Avoid ergotamine

No seizure

·      MgSO4

No haemorrhage

·      Blood tests pre-op

·      TXA

No paralysis

·      Blood tests pre-op

·      Plt >80: spinal

·      Plt 50-80: pros vs cons. Consider trend.

·      Plt <50: GA

No drowning

·      IDC for monitoring

·      Titrate IV fluid to UO 0.5mL/kg/h

·      Concentrated oxytocin infusion

 

Goals: foetus

No asphyxia

·      Avoid maternal hypotension too. Aim mAP >70

·      Continuous CTG

No lung injury

·      Delay delivery if safe

·      Glucocorticoids if <35/40

No brain injury

·      MgSO4 if <32/40

 

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