O+G
Signs suggesting seizure is eclamptic
PromptImportant examination findings in preeclampsia
ResponseHypertension >140/90 (or rise >30/15)
Peripheral oedema
Hyperreflexia/Clonus
Tender hepatomegaly/RUQ tenderness
Papilloedema
Visual field defects
Pulmonary oedema
Peripheral oedema
Hyperreflexia/Clonus
Tender hepatomegaly/RUQ tenderness
Papilloedema
Visual field defects
Pulmonary oedema
PromptList and justify investigations in preeclampsia
ResponseUrinalysis - proteinuria, WCC, casts (protein 2+ on dip sufficient)
EUC’s - AKI
LFT’s ? HELLP syndrome
FBC + LDH - haemolysis ? HELLP syndrome
Uric acid ? preeclampsia
Blood film ? haemolyis
Heamolytic screen (reticulocytes, haptoglobin, conjugated/unconjugated bili, ?Haemolysis)
Lipase exclude pancreatitis (if abdo pain)
Septic screen
U/S liver ? haematoma/rupture (This was in one answer and seems drastic)
CTG monitoring ?foetal distress/viability
EUC’s - AKI
LFT’s ? HELLP syndrome
FBC + LDH - haemolysis ? HELLP syndrome
Uric acid ? preeclampsia
Blood film ? haemolyis
Heamolytic screen (reticulocytes, haptoglobin, conjugated/unconjugated bili, ?Haemolysis)
Lipase exclude pancreatitis (if abdo pain)
Septic screen
U/S liver ? haematoma/rupture (This was in one answer and seems drastic)
CTG monitoring ?foetal distress/viability
PromptDifferential diagnosis preeclampsia bloods (Obviously depends on the question asked)
Low Hb, Low plt
High Bili, High creat
High INR, high APTT
Low Hb, Low plt
High Bili, High creat
High INR, high APTT
ResponsePreeclampsia
HELLP syndrome
HUS-TTP
Sepsis with DIC
Biliary disease
Acute fatty liver of pregnancy
HELLP syndrome
HUS-TTP
Sepsis with DIC
Biliary disease
Acute fatty liver of pregnancy
PromptManagement priorities in preeclampsia
ResponseIV access, resus bed
O+G, anaesthetics, Paeds - ? needs immediate delivery
Treat hypertension - IV hydralazine 5mg Q5 min, SBP<150, DBP <105
Seizure prevention - MgSO4 4g IV + infusion thereafter
Correct coagulopathy if present
RANZCOG Htn treatment:
Labetaolol 10 mg IV Q10 min to 80 mg
Hydralazine
Nifedipine 10-20 mg PO
O+G, anaesthetics, Paeds - ? needs immediate delivery
Treat hypertension - IV hydralazine 5mg Q5 min, SBP<150, DBP <105
Seizure prevention - MgSO4 4g IV + infusion thereafter
Correct coagulopathy if present
RANZCOG Htn treatment:
Labetaolol 10 mg IV Q10 min to 80 mg
Hydralazine
Nifedipine 10-20 mg PO
PromptSeizure treatment in Eclampsia
(In any question they always seize. Be prepared for seizure)
(In any question they always seize. Be prepared for seizure)
Responseprevent hypoxia
BP control
- Airway control/aspiration
- left lateral to prevent aortocaval compression (Or wedge under R hip)
- Sats >92%
- 4g magnesium over 10 min (?5-20 min) + further 2g if refractory, followed by 1-2g/hr infusion. (note 4g = 16mmol).
- Midazolam 5mg (second line)
- End point - Aim Mg 2.0-4.0, Hyporeflexia
BP control
- Hydralazine 5-10 mg
- Labetalol 10-20 mg IV Q5 min
- GTN/SNP if severe
- Steroids for foetal lung maturation (this baby’s gonna get delivered)
- Foetal wellbeing assessment (CTG/U/S)
- ?Anti D
PromptComplications of preeclampsia
ResponseSeizures (Eclampsia)
Maternal or foetal death (Or both!)
Pulmonary oedema
HELLP syndrome
AKI
DIC
Subcapsular liver haematoma
Maternal or foetal death (Or both!)
Pulmonary oedema
HELLP syndrome
AKI
DIC
Subcapsular liver haematoma
PromptHELLP syndrome definition
ResponseProbably a severe form of preeclampsia (bit controversial), but ~20% won’t have hypertension
Haemolyis
Elevated Liver enzymes
Low Platelets
No specific examination findings - diagnosis on bloods
Haemolyis
Elevated Liver enzymes
Low Platelets
No specific examination findings - diagnosis on bloods
Peripheral oedema
Hyperreflexia/clonus