Obstetrics and Gynaecology for NEET-PG
Pre-eclampsia and Eclampsia for NEET-PG
Pre-eclampsia is new-onset hypertension after 20 weeks of gestation with proteinuria or evidence of maternal organ dysfunction, and eclampsia is the occurrence of generalised tonic-clonic seizures in a pre-eclamptic woman not attributable to another cause. For NEET-PG, the diagnostic thresholds, the definition of severe features, and magnesium sulphate as the drug of choice for seizure control and prophylaxis are the most tested points. Pre-eclampsia arises from abnormal trophoblastic invasion of the spiral arteries, leading to placental ischaemia, release of antiangiogenic factors, and widespread endothelial dysfunction. Blood pressure of 140/90 mmHg or higher on two occasions defines hypertension, and severe disease is marked by pressures of 160/110 mmHg or higher, thrombocytopenia, deranged liver enzymes, renal impairment, pulmonary oedema, or cerebral and visual symptoms. HELLP syndrome, comprising haemolysis, elevated liver enzymes, and low platelets, is a dangerous variant. Definitive treatment is delivery of the fetus and placenta, timed against gestational age and severity. Magnesium sulphate prevents and treats eclamptic seizures, with monitoring of reflexes, respiratory rate, and urine output because calcium gluconate is the antidote for toxicity. Antihypertensives such as labetalol, hydralazine, and nifedipine control severe hypertension, and low-dose aspirin reduces recurrence risk in high-risk women. Knowing the magnesium regimen, toxicity signs, and delivery as cure are recurring anchors.
MedNext Academy | 3 min read
Pre-eclampsia and Eclampsia for NEET-PG
Pre-eclampsia is new-onset hypertension after 20 weeks of gestation with proteinuria or evidence of maternal organ dysfunction, and eclampsia is the occurrence of generalised tonic-clonic seizures in a pre-eclamptic woman not attributable to another cause. For NEET-PG, the diagnostic thresholds, the definition of severe features, and magnesium sulphate as the drug of choice for seizure control and prophylaxis are the most tested points. Pre-eclampsia arises from abnormal trophoblastic invasion of the spiral arteries, leading to placental ischaemia, release of antiangiogenic factors, and widespread endothelial dysfunction. Blood pressure of 140/90 mmHg or higher on two occasions defines hypertension, and severe disease is marked by pressures of 160/110 mmHg or higher, thrombocytopenia, deranged liver enzymes, renal impairment, pulmonary oedema, or cerebral and visual symptoms. HELLP syndrome, comprising haemolysis, elevated liver enzymes, and low platelets, is a dangerous variant. Definitive treatment is delivery of the fetus and placenta, timed against gestational age and severity. Magnesium sulphate prevents and treats eclamptic seizures, with monitoring of reflexes, respiratory rate, and urine output because calcium gluconate is the antidote for toxicity. Antihypertensives such as labetalol, hydralazine, and nifedipine control severe hypertension, and low-dose aspirin reduces recurrence risk in high-risk women. Knowing the magnesium regimen, toxicity signs, and delivery as cure are recurring anchors.
Pre-eclampsia is new-onset hypertension after 20 weeks of gestation with proteinuria or evidence of maternal organ dysfunction, and eclampsia is the occurrence of generalised tonic-clonic seizures in a pre-eclamptic woman not attributable to another cause. For NEET-PG, the diagnostic thresholds, the definition of severe features, and magnesium sulphate as the drug of choice for seizure control and prophylaxis are the most tested points. Pre-eclampsia arises from abnormal trophoblastic invasion of the spiral arteries, leading to placental ischaemia, release of antiangiogenic factors, and widespread endothelial dysfunction. Blood pressure of 140/90 mmHg or higher on two occasions defines hypertension, and severe disease is marked by pressures of 160/110 mmHg or higher, thrombocytopenia, deranged liver enzymes, renal impairment, pulmonary oedema, or cerebral and visual symptoms. HELLP syndrome, comprising haemolysis, elevated liver enzymes, and low platelets, is a dangerous variant. Definitive treatment is delivery of the fetus and placenta, timed against gestational age and severity. Magnesium sulphate prevents and treats eclamptic seizures, with monitoring of reflexes, respiratory rate, and urine output because calcium gluconate is the antidote for toxicity. Antihypertensives such as labetalol, hydralazine, and nifedipine control severe hypertension, and low-dose aspirin reduces recurrence risk in high-risk women. Knowing the magnesium regimen, toxicity signs, and delivery as cure are recurring anchors.
Key points
- **Definition:** New hypertension after 20 weeks with proteinuria or organ dysfunction. Eclampsia is seizures superimposed on pre-eclampsia.
- **Blood pressure thresholds:** 140/90 mmHg or higher defines hypertension. 160/110 mmHg or higher indicates severe disease needing urgent treatment.
- **Pathogenesis:** Defective trophoblastic invasion of spiral arteries causes placental ischaemia, antiangiogenic factor release, and endothelial dysfunction.
- **Severe features:** Thrombocytopenia, raised transaminases, renal impairment, pulmonary oedema, and new cerebral or visual symptoms mark severe pre-eclampsia.
- **HELLP syndrome:** Haemolysis, elevated liver enzymes, and low platelets. A severe variant that can occur even with only mildly raised blood pressure.
- **Magnesium sulphate:** Drug of choice to prevent and treat eclamptic seizures. It is superior to diazepam and phenytoin for seizure control.
- **Magnesium toxicity:** Loss of deep tendon reflexes first, then respiratory depression and cardiac arrest. Monitor reflexes, respiration, and urine output.
- **Magnesium antidote:** Intravenous calcium gluconate reverses magnesium toxicity and must be kept available during administration.
- **Definitive cure:** Delivery of the fetus and placenta is the only definitive treatment. Timing balances maternal risk against fetal maturity.
- **Antihypertensives:** Labetalol, hydralazine, and oral nifedipine are used for acute severe hypertension. ACE inhibitors are contraindicated in pregnancy.
- **Prevention:** Low-dose aspirin started before 16 weeks reduces pre-eclampsia risk in high-risk women. Calcium supplementation helps in low-intake populations.
Frequently Asked Questions
What defines pre-eclampsia?
It is new-onset hypertension of 140/90 mmHg or higher after 20 weeks of gestation, accompanied by proteinuria or maternal organ dysfunction.
What is the drug of choice for eclamptic seizures?
Magnesium sulphate is the drug of choice for both preventing and treating eclamptic seizures, and it outperforms diazepam and phenytoin.
What are the signs of magnesium toxicity?
The earliest sign is loss of deep tendon reflexes, followed by respiratory depression and cardiac arrest. Calcium gluconate is the antidote.
What is the definitive treatment of pre-eclampsia?
Delivery of the fetus and placenta is the only definitive cure. The timing depends on disease severity and gestational age.
What is HELLP syndrome?
HELLP is a severe variant of pre-eclampsia defined by haemolysis, elevated liver enzymes, and low platelet count, and it can occur with only mild hypertension.
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