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Pre eclampsia short note from wylie

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"Pre-Eclampsia"[MeSH Terms]

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pre-eclampsia diagnosis management NICE guideline 2025

Pre-eclampsia

Definition: A multisystem disorder of pregnancy characterized by new-onset hypertension after 20 weeks of gestation with either:
  • Proteinuria, or
  • Maternal organ dysfunction or uteroplacental dysfunction, even without proteinuria.
Hypertension is BP ≥140/90 mmHg on two readings. Severe hypertension is ≥160/110 mmHg.

Etiopathogenesis

Abnormal trophoblastic invasion causes inadequate remodeling of spiral arteries. Resultant placental ischemia releases antiangiogenic and inflammatory factors, producing widespread maternal endothelial dysfunction, vasospasm, capillary leak, and activation of coagulation.

Risk factors

  • Previous pre-eclampsia or family history
  • First pregnancy, multiple pregnancy
  • Chronic hypertension, renal disease, diabetes mellitus
  • Antiphospholipid syndrome/SLE
  • Obesity, advanced maternal age
  • Assisted reproduction

Clinical features

  • Hypertension and proteinuria
  • Sudden edema, excessive weight gain
  • Headache, visual disturbance, hyperreflexia
  • Epigastric or right upper-quadrant pain, nausea/vomiting
  • Oliguria
  • Reduced fetal movements due to fetal growth restriction.

Investigations

Maternal
  • Urine protein: protein-creatinine ratio or 24-hour urine protein
  • CBC and platelet count
  • Liver enzymes, bilirubin, LDH
  • Serum creatinine, uric acid
  • Coagulation profile if severe disease/HELLP suspected.
Fetal
  • Ultrasound for growth and liquor volume
  • Umbilical artery Doppler
  • CTG/non-stress test.

Severe features / complications

  • BP ≥160/110 mmHg
  • Persistent severe headache, visual symptoms, or epigastric pain
  • Thrombocytopenia, rising liver enzymes, renal impairment
  • Pulmonary edema
  • Fetal growth restriction or abnormal Doppler
  • Eclampsia, HELLP syndrome, placental abruption, DIC, fetal hypoxia/death.

Management

Definitive treatment is delivery of the placenta.
  • Admit and monitor mother and fetus.
  • Control severe hypertension with labetalol, nifedipine, or hydralazine.
  • Give magnesium sulfate for seizure prophylaxis/treatment in severe pre-eclampsia or eclampsia.
  • Corticosteroids if preterm delivery is likely, for fetal lung maturation.
  • Timing of delivery depends on maternal condition, fetal status, gestational age, and cervical favorability. Immediate delivery is indicated for uncontrolled severe disease, eclampsia, HELLP syndrome, abruption, or fetal compromise.
  • During labour and postpartum, continue close BP, fluid-balance, and neurological monitoring.
Current NICE guidance includes CTG at diagnosis and ultrasound with umbilical artery Doppler when conservative management is planned, as outlined in the NICE hypertension-in-pregnancy guideline.

Prevention

For high-risk women: early antenatal booking, optimization of chronic medical disease, and low-dose aspirin from early pregnancy until birth according to local protocol. Calcium supplementation is useful where dietary calcium intake is low.
Key point: Pre-eclampsia may occur without obvious edema or proteinuria, so hypertension with maternal organ dysfunction or fetal growth restriction should prompt evaluation.

Only wylie text book

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I cannot provide it from Wylie’s textbook because Wylie and Churchill-Davidson’s A Practice of Anaesthesia is not available in the current textbook library. The available obstetric references are Berek & Novak and Creasy & Resnik.
Upload the relevant Wylie pages or allow one of those sources, and I will make the short note strictly from that text.
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