Overview

• Pre-Eclampsia → new hypertension (≥140/90) in pregnancy with end-organ dysfunction. Usually occurs >20 weeks gestation, when the spiral arteries of the placenta form abnormally, leading to high vascular resistance in these vessels.
  • Triad → hypertension, proteinuria, oedema.
  • Normally in pregnancy → BP falls in first half until 20-24 weeks. After this, begins to rise to pre-pregnancy levels by term.
• Definitions ⇒

  • Chronic Hypertension → high BP that exists <20 weeks gestation and is longstanding (ie. not caused by dysfunction in the placenta).

    • Pre-Existing HTN → need to stop ACEi/ARB/TLD and contact GP to switch (ideally prior to getting pregnant - when planning). IF ON CCB CAN CONTINUE. 1st Line = labetalol, 2nd Line = nifedipine.

    <aside> 💡 Hypertension before 20 weeks → chronic hypertension (too early for gestational or pre-eclampsia).

    </aside>

  • Gestational Hypertension (Pregnancy-Induced Hypertension) → occurs >20 weeks gestation, without proteinuria. (Benign, not associated with adverse outcomes, but may progress to pre-eclampsia).

    • BP ≥140/90mmHg on two occasions (at least 4 hours apart) during pregnancy after 20 weeks gestation in a previously normotensive patient, without the presence of proteinuria or other clinical features suggestive of pre-eclampsia.

  • Pre-Eclampsia → pregnancy-induced hypertension associated with organ damage, notably proteinuria.

  • Eclampsia → when seizures occur as a result of pre-eclampsia.

• Risk Factors ⇒
  • High-Risk Factors → pre-existing hypertension, previous hypertension in pregnancy, existing autoimmune conditions (SLE), diabetes, CKD.
  • Moderate-Risk Factors → age >40, BMI >35, >10 years since previous pregnancy, multiple pregnancy, first pregnancy, FH of pre-eclampsia.
  • 1 high-risk factor OR ≥2 moderate risk-factors → offer aspirin 150mg (low-dose) from 12 weeks gestation until birth.

Making Diagnosis

Clinical Features

• Headache.
• Visual disturbance or bluriness.
• Nausea and vomiting.
• Upper abdominal or epigastric pain.
• Oedema.
• Hyperreflexia (clonus) → associated with cerebral involvement and development of seizures.
• Reduced urine output (oliguria).
• Seizures.

Investigations

• Diagnosis → BP >140/90 mmHg PLUS any of proteinuria, organ dysfunction or placental dysfunction.
  • Proteinuria → if dipstick is 1+, quantify proteinuria using ACR (>8mg/mol) or PCR (>30mg/mol) [PCR > 24 hr urine collection].
  • Organ (Mainly Kidney + Liver) Dysfunction (do FBC, U&Es, LFTs) → raised creatinine, elevated liver enzymes, seizures, thrombocytopenia. Fundoscopy.
  • Placental Dysfunction → fetal growth restriction (may have low SFH), abnormal doppler.
• Placental Growth Factor (PlGF) → test on one occasion during pregnancy in women suspected of pre-eclampsia. Levels are low in pre-eclampsia. Use between 20-35 weeks gestation to rule out pre-eclampsia.