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  • Dr.Niraj Mahajan
  • Dr.Niraj Mahajan
  • Dr.Niraj Mahajan
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    Pre-eclampsia

    By AdminPosted On 05-Oct-2016

    1. The proteinuria in Pre-eclampsia contains?


    a) Only albumin

    b) Only globulin

    c) More albumin than globulin

    d) More globulin than albumin

    e) Equal amount of albumin and globulin

    Correct Answer: c) More albumin than globulin. Albuminuria is an incorrect term to describe proteinuria of preeclampsia (PE). As with any other glomerulopathy, there is increased permeability to most large-molecular-weight proteins; thus, abnormal albumin excretion is accompanied by other proteins; such as hemoglobin, globulins, and transferrin. Although plasma contains both albumin and globulin, the latter is much less likely to appear in the urine. With mild or moderate damage, smaller proteins such as albumin will pass and only with severe damage will globulins pass. Proteinuria is usually albuminuria, but if globulin is lost too, there is serious pathology in the glomeruli. (Ref: William's Obstetrics).


    2. Regarding pre-eclampsia, proteinuria is defined as


    a) >= 100 mg/24 hour urine.

    b) >= 200 mg/24 hour urine.

    c) >= 300 mg/24 hour urine.

    d) >= 500 mg/24 hour urine.

    e) >= 300 mg/36 hour urine.

    Correct Answer: c) >= 300 mg/24 hour urine. Pre-eclampsia - eclampsia is a syndrome that manifests clinically as new-onset hypertension in later pregnancy (any time after 20 weeks, but usually closer to term), with associated proteinuria: 1+ on dipstick and, officially, ≥300 mg per 24-hour urine collection (Ref: American Heart Association 2008).


    3. Treatment of Pre-eclampsia


    Primi, 32 wks, previously normo-tensive, presents with BP of 140/90 mmHg on two separate occasion 6hrs apart and trace proteinuria. Which of the following medicine/s you would prescribe?


    a) Alpha methyl dopa

    b) Labetelol

    c) Betamethasone

    d) Magnesium sulphate

    e) Nifedipine

    f) No medicines required


    Correct Answer: f) or even c). For Mild hypertension (140/90 to 149/99 mmHg) No treatment is required unless BP is >149/99 mmHg (NICE Guidelines: 2011). A course of steroid may be considered as some women may progress to moderate to severe hypertension which will require termination of pregnancy before 35 weeks of gestation.


    4. Antihypertensive pregnancy


    The most important reason to give antihypertensive drug for hypertension in pregnancy is to decrease the


    a) Incidence of IUGR

    b) Incidence of oligohydraminos

    c) Incidence of fetal death

    d) Incidence of placental abruption

    e) Risk of maternal complications such as eclampsia and stroke

    Correct Answer: e) Risk of maternal complications such as eclampsia and stroke. Lowering systemic BP is not believed to reverse the primary pathogenic process, and antihypertensive medication has never been demonstrated to “cure” or reverse preeclampsia. Nevertheless, because preeclampsia may develop suddenly in young, previously normotensive women, prevention of cardiovascular and cerebrovascular consequences of severe and rapid elevations of BP is an important goal of clinical management, often requiring judicious use of antihypertensive medication (Ref: American Heart Association 2008).


    5. Magnesium Sulphate for Severe Pre-eclampsia


    You are asked to assess a patient who is receiving magnesium sulphate for severe pre-eclampsia. She has passed only 5 ml urine in the last 2 hours. Her deep tendon reflexes are absent. What other observation should you take?


    a) Blood pressure

    b) Glasgow coma score

    c) Pulse rate

    d) Respiratory rate

    e) Temperature


    Correct Answer: d) Respiratory rate. This patient has signs of magnesium toxicity (absent deep tendon reflexes), which is probably secondary to renal impairment. Respiratory depression is a sign of increasing magnesium toxicity is; therefore, the most appropriate follow-up would be to investigate the patient’s respiratory rate.


    6. Antihypertensive treatment in Pre-eclampsia


    a) Reduce the placental blood flow.

    b) Cure Pre-eclampsia syndrome.

    c) Reduce the risk of CVA in the mother.

    d) Prevent hypertensive renal disease.

    e) Prevent myocardial infarction.

    Correct Answer: c) Reduce the risk of CVA in the mother. Lowering systemic BP is not believed to reverse the primary pathogenic process, and antihypertensive medication has never been demonstrated to “cure” or reverse preeclampsia. Nevertheless, because preeclampsia may develop suddenly in young, previously normotensive women, prevention of cardiovascular and cerebrovascular consequences of severe and rapid elevations of BP is an important goal of clinical management, often requiring judicious use of antihypertensive medication (Ref: American Heart Association 2008).


    7. Severe Pre-eclampsia with DIC and ARF


    Severe pre-eclampsia, 34 weeks, 65 kg, has hematuria but maintaining urine output. Delivered by cesarean section. 250 cc retroplacental clot present. How would you prevent eclampsia in this patient?


    a) Pritchard regime (4 gm IV, 5 gm IM each buttock)

    b) Low dose Magnessium sulphate therapy

    c) Phenytoin 600 mg loading followed by 100 mg 8 hrly

    d) Magnessium sulphate 1-2 gm/hour in a IV drip

    e) No need of anticonvulsant as she is in DIC


    Correct Answer: d) Zuspan regimen. Patient is already in DIC, so one would like to avoid IM dose of magnesium sulphate as we have to inject 10+10 ml of solution, which can cause haematoma. Disease process is severe so we definitely need to give MagSulf, as 1st drug of choice. DIC is not contraindication as urine output is there. Magpie trial recommends full dose of Magsulf even for mild PE. One can administer complete Zuspan regime with loading dose of 4gm and maintainance dose of 1gm/hr. I prefer only maintenance dose for PE, and it never failed.


    8. Placenta in Pre-eclampsia


    The placenta from a 29-year-old woman is examined following induced delivery for fetal distress at 32 weeks of gestation and maternal proteinuria, and demonstrates multiple placental infarcts and villus features suggesting significant reduction in utero-placental insufficiency. Regarding placental pathology, match the correct response:


    a) Complete hydatidiform mole

    b) Chorioamnionitis

    c) Partial hydatidiform mole

    d) Pre-eclampsia

    e) Miscarriage

    Correct Answer: d) Pre-eclampsia


    Clinical description of the patient matches pre-eclampsia of all the given options. Placental infarcts and reduction in uteroplacental blood flow are found in preeclampsia. Chronic inflammatory and placental vasoocclusive lesions are more common in preterm preeclampsia than in spontaneous prematurity. More frequent in preeclampsia versus spontaneous prematurity are chronic uteroplacental vasculitis (29% vs 20%), chronic villitis (20% vs 3%), avascular villi (39% vs 16%), and "hemorrhagic endovasculitis" (9% vs 2.5%).


    9. Most definitive treatment for Pre-eclampsia is


    a) IV Magnesium sulphate

    b) Diazepam.

    c) Delivery

    d) IV Hydralazine

    e) IV Labetalol

    Correct Answer: c) Delivery. Lowering systemic BP is not believed to reverse the primary pathogenic process, and antihypertensive medication has never been demonstrated to “cure” or reverse preeclampsia. The definitive treatment of eclampsia is delivery. Attempts to prolong pregnancy in order to improve fetal maturity are unlikely to be of value.


    10. In Pre-eclampsia, right upper quadrant part abdominal pain is due


    a) Subcapsular haemorrhage of liver

    b) Cholecystitis

    c) Hemorrhagic gastritis

    d) Gastric ulcer

    e) Oesophagitis

    Correct Answer: a) Subcapsular haemorrhage of liver. Right upper quadrant part abdominal pain reflects hepatic ischemia or capsular distention.


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    Dr. Niraj Mahajan

    MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.

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