Preeclampsia and Eclampsia Management — MCQs

10 questions

A 25-year-old lady, Neethu, in her 22nd week of pregnancy develops hypertension and mild proteinuria. Due to the baby's gestational age, her obstetrician chooses to carefully monitor the mother for any sign of developing complications rather than to immediately deliver the baby. Which of the following complications account for the most maternal deaths in preeclampsia?

Anesthesia of choice for cesarean section in severe preeclampsia:-

What is the management of eclampsia at 34 weeks of pregnancy?

Pregnancy-associated risk factors for pre-eclampsia include all except which of the following?

The Anaesthesia technique of choice in severely preeclamptic women for cesarean delivery -

What is the definitive treatment for preeclampsia?

Which of the following hormones in pregnancy is more associated with blood vessels and increased permeability?

A 32-year-old primigravida at 39 weeks of gestational age has a blood pressure reading of 150/100 mmHg obtained during a routine visit, which is an elevation from her baseline blood pressure of 120/70 mmHg. She denies any headache, visual changes, nausea, vomiting, or abdominal pain. Her repeat BP is 160/90 mmHg, and urinalysis is negative for protein. Which of the following is the most likely diagnosis?

Which of the following is advised for severe preeclampsia complicating cesarean delivery?

Q10

A 32-year-old female at 36 weeks of pregnancy presents with BP 170/100 mmHg, visual disturbances, headache, urine protein 3+. What will be the next step?

Preeclampsia and Eclampsia Management Indian Medical PG Practice Questions and MCQs

Question 1: A 25-year-old lady, Neethu, in her 22nd week of pregnancy develops hypertension and mild proteinuria. Due to the baby's gestational age, her obstetrician chooses to carefully monitor the mother for any sign of developing complications rather than to immediately deliver the baby. Which of the following complications account for the most maternal deaths in preeclampsia?

A. Cerebral hemorrhage and acute respiratory distress syndrome (Correct Answer)
B. Cerebral edema and laryngeal edema
C. Convulsions and renal tubular necrosis
D. Hemolysis and hepatic infection

Explanation: ***Cerebral hemorrhage and acute respiratory distress syndrome*** - **Cerebral hemorrhage** is the leading cause of maternal death in preeclampsia/eclampsia, accounting for approximately 20-30% of maternal deaths, often resulting from uncontrolled severe hypertension leading to rupture of cerebral vessels. - **Acute Respiratory Distress Syndrome (ARDS)** is another major cause of maternal mortality in severe preeclampsia, developing due to endothelial dysfunction, capillary leak, and pulmonary edema leading to significant respiratory compromise. *Cerebral edema and laryngeal edema* - While **cerebral edema** can occur in severe preeclampsia and contribute to neurological complications, **cerebral hemorrhage** is the more direct and fatal cerebrovascular complication. - **Laryngeal edema** is rare in preeclampsia and not considered a primary cause of maternal death; it may occur with aggressive fluid resuscitation or as part of airway management complications. *Convulsions and renal tubular necrosis* - **Convulsions (eclampsia)** are a serious complication, but they are not the direct cause of death; rather, **cerebral hemorrhage** following eclamptic seizures or from uncontrolled hypertension is the actual fatal event. - **Acute tubular necrosis** can lead to acute kidney injury, but with modern dialysis and supportive care, renal failure is rarely a direct cause of maternal death compared to acute cerebrovascular or respiratory events. *Hemolysis and hepatic infection* - **Hemolysis** is a component of HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), a severe form of preeclampsia, but hemolysis itself is not typically the direct cause of death; associated complications like hepatic rupture or cerebral hemorrhage are the fatal events. - **Hepatic infection** is not a complication of preeclampsia; preeclampsia can lead to hepatic dysfunction, subcapsular hematoma, or hepatic rupture in HELLP syndrome, but not infection.

Question 2: Anesthesia of choice for cesarean section in severe preeclampsia:-

A. Spinal (Correct Answer)
B. GA
C. Epidural
D. Combined spinal-epidural (CSE)

Explanation: ***Spinal*** - **Spinal anesthesia** is generally preferred in severe preeclampsia because it provides **rapid onset** of dense block, which can be critical for emergent cesarean sections. - It avoids the risks associated with general anesthesia in these patients, such as difficult intubation and exaggerated **hypertensive response** to laryngoscopy. *GA* - **General anesthesia (GA)** in severe preeclampsia carries increased risks due to **airway edema**, potential for difficult intubation, and significant **blood pressure fluctuations** during induction and intubation. - It can exacerbate the already compromised uteroplacental perfusion due to the sympathetic blockade and the potential for a **hypotensive episode**. *Epidural* - While generally safe in less severe preeclampsia, an **epidural** has a **slower onset** compared to spinal anesthesia, which may be a disadvantage in emergent situations. - The gradual sympathetic blockade with an epidural is often preferred to avoid sudden drops in blood pressure, but the delay in achieving a surgical block might not be acceptable in severe, unstable cases. *Combined spinal-epidural (CSE)* - **Combined spinal-epidural (CSE)** offers the rapid onset of a spinal block with the flexibility of an epidural catheter for prolonged anesthesia or postoperative pain control. - However, in cases of severe preeclampsia where **hemodynamic instability** is a major concern, the relatively larger dose of local anesthetic required for epidural component can lead to a more pronounced or rapid drop in blood pressure.

Question 3: What is the management of eclampsia at 34 weeks of pregnancy?

A. Continue convulsions and wait for 37 weeks to complete.
B. Wait for spontaneous labor.
C. Continue blood pressure management.
D. Administer antihypertensives, anticonvulsants, and consider termination of pregnancy. (Correct Answer)

Explanation: **Administer antihypertensives, anticonvulsants, and consider termination of pregnancy.** - In eclampsia, emergent management includes immediate administration of **magnesium sulfate** as an anticonvulsant and **antihypertensives** (e.g., labetalol, hydralazine, nifedipine) to control blood pressure. - Given the gestational age of 34 weeks and the occurrence of eclampsia, **delivery of the fetus** is often indicated to resolve the maternal condition, regardless of fetal lung maturity. *Continue convulsions and wait for 37 weeks to complete.* - Allowing **convulsions to continue** is extremely dangerous for both mother and fetus, increasing risks of aspiration, trauma, hypoxemia, and placental abruption. - Eclampsia is a severe complication of pregnancy that necessitates immediate intervention and **should not be passively observed** until full term. *Wait for spontaneous labor.* - **Delaying delivery** while waiting for spontaneous labor in eclampsia significantly prolongs the mother's exposure to the severe complications of the condition. - Eclampsia is an ** obstetric emergency** where prompt delivery, often via induction or C-section, is the definitive cure. *Continue blood pressure management.* - While **blood pressure management** is a crucial component of eclampsia treatment, it is insufficient on its own. - Eclampsia specifically involves **seizures**, which require anticonvulsant therapy (magnesium sulfate) in addition to antihypertensives, and the ultimate treatment is delivery.

Question 4: Pregnancy-associated risk factors for pre-eclampsia include all except which of the following?

A. Rh incompatibility (Correct Answer)
B. Fetal structural abnormalities
C. Trisomy 13
D. Multiple pregnancy

Explanation: ***Rh incompatibility*** - **Rh incompatibility** is a risk factor for **hemolytic disease of the newborn** and not typically a direct risk factor for **pre-eclampsia**. - Its pathophysiology involves an immune response against fetal red blood cells, distinct from the placental dysfunction seen in pre-eclampsia. *Multiple pregnancy* - **Multiple pregnancies** significantly increase the risk of pre-eclampsia due to a larger placental mass and increased demands on the maternal cardiovascular system. - The elevated placental burden leads to greater production of anti-angiogenic factors, contributing to the development of the disorder. *Fetal structural abnormalities* - While not all **fetal structural abnormalities** increase pre-eclampsia risk, those associated with **poor placental development** or dysfunction, like certain genetic syndromes, can elevate the risk. - This connection is related to impaired placental development and function, similar to severe cases of pre-eclampsia without overt fetal anomalies. *Trisomy 13* - **Trisomy 13** (Patau syndrome) is strongly associated with an increased risk of severe and early-onset **pre-eclampsia**. - The presence of this chromosomal abnormality often leads to significant placental dysfunction and shallow trophoblast invasion, which are hallmarks of pre-eclampsia.

Question 5: The Anaesthesia technique of choice in severely preeclamptic women for cesarean delivery -

A. Spinal Anaesthesia (Correct Answer)
B. General Anaesthesia
C. Epidural Anaesthesia
D. Pudendal block

Explanation: ***Spinal Anaesthesia*** - **Spinal anaesthesia** is generally preferred due to its rapid onset, excellent muscle relaxation, and better hemodynamic stability compared to general anaesthesia when careful fluid management is in place. - It avoids the risks associated with **difficult airway management** and aspiration in preeclamptic patients and minimizes fetal drug exposure. *General Anaesthesia* - **General anaesthesia** carries a higher risk of **rapid, unpredictable increases in blood pressure** during tracheal intubation and extubation, which can be dangerous in preeclampsia with an already compromised cardiovascular system. - It is associated with increased risks of **aspiration**, **difficult airway**, and **postoperative respiratory complications** in preeclamptic women. *Epidural Anaesthesia* - While generally safe, **epidural anaesthesia** has a slower onset compared to spinal anaesthesia, which may not be ideal in emergency situations requiring rapid delivery. - The titration of an epidural can be more challenging in patients with severe preeclampsia, where rapid changes in blood pressure need careful management. *Pudendal block* - A **pudendal block** provides local anaesthesia to the perineum, vulva, and lower vagina. - It is used for pain relief during vaginal delivery and is unsuitable for a **cesarean section**, which requires anaesthesia of the abdominal wall and uterus.

Question 6: What is the definitive treatment for preeclampsia?

A. Delivery of the baby (Correct Answer)
B. Use of antihypertensive medications
C. Dietary modifications
D. Increased rest and monitoring

Explanation: ***Delivery of the baby*** - **Preeclampsia** is a multisystem disorder of pregnancy; its pathogenesis is directly linked to the **placenta**. - **Removal of the placenta** through delivery is the only definitive cure for preeclampsia, leading to the resolution of symptoms. *Use of antihypertensive medications* - Antihypertensive medications are used to **manage blood pressure** in preeclampsia, preventing complications like stroke. - They **do not address the underlying cause** of the disease and are not a curative treatment. *Dietary modifications* - While a healthy diet is important during pregnancy, **dietary modifications** alone cannot resolve the pathological processes of preeclampsia. - There is **no specific diet** proven to cure or prevent preeclampsia. *Increased rest and monitoring* - **Increased rest and close monitoring** are supportive measures that can help manage symptoms and detect complications. - These interventions **do not reverse the disease process** and are not a definitive treatment.

Question 7: Which of the following hormones in pregnancy is more associated with blood vessels and increased permeability?

A. Estrogen (Correct Answer)
B. Prolactin
C. Relaxin
D. Progesterone

Explanation: ***Estrogen*** - **Estrogen** levels increase significantly during pregnancy and are known to cause **vasodilation** and increased vascular permeability. - This hormonal influence contributes to common pregnancy symptoms like **edema**, increased blood flow to various organs, and changes in vascular tone. - Estrogen is the primary hormone responsible for systemic vascular changes during pregnancy. *Prolactin* - **Prolactin** is primarily responsible for **milk production** (lactation) and breast development during pregnancy. - While it has various metabolic effects, it is not directly associated with increased vascular permeability in the way estrogen is during pregnancy. *Relaxin* - **Relaxin** is a pregnancy hormone that does affect blood vessels and connective tissue remodeling. - However, its primary vascular effects are on **increasing vascular compliance** and **remodeling of maternal tissues** to accommodate pregnancy, rather than directly increasing permeability. - While relaxin contributes to hemodynamic changes, estrogen has a more direct and prominent role in increasing vascular permeability. *Progesterone* - **Progesterone** is crucial for maintaining pregnancy, relaxing smooth muscles, and supporting the uterine lining. - While it can affect vascular tone and causes some vasodilation, its primary role is not to directly increase blood vessel permeability to the same extent as estrogen.

Question 8: A 32-year-old primigravida at 39 weeks of gestational age has a blood pressure reading of 150/100 mmHg obtained during a routine visit, which is an elevation from her baseline blood pressure of 120/70 mmHg. She denies any headache, visual changes, nausea, vomiting, or abdominal pain. Her repeat BP is 160/90 mmHg, and urinalysis is negative for protein. Which of the following is the most likely diagnosis?

A. Preeclampsia
B. Chronic hypertension with superimposed preeclampsia
C. Eclampsia
D. Gestational hypertension (Correct Answer)

Explanation: ***Gestational hypertension*** - This patient presents with **new-onset hypertension** (BP > 140/90 mmHg) after 20 weeks of gestation, without **proteinuria** or signs of **end-organ damage**. - The absence of proteinuria and severe features distinguishes it from preeclampsia, making gestational hypertension the most likely diagnosis. *Preeclampsia* - Preeclampsia requires new-onset hypertension combined with **proteinuria** (≥300 mg in 24 hours or protein/creatinine ratio ≥0.3) or signs of **end-organ dysfunction**, neither of which are described here. - While hypertension is present, the **lack of proteinuria** or other severe features rules out this diagnosis. *Chronic hypertension with superimposed preeclampsia* - This diagnosis applies to women with **pre-existing hypertension** (diagnosed before pregnancy or before 20 weeks) who then develop new-onset proteinuria or worsening hypertension with severe features. - The patient's baseline blood pressure was normal (120/70 mmHg), indicating no chronic hypertension, and no proteinuria or severe features are present. *Eclampsia* - Eclampsia is defined by the occurrence of **generalized tonic-clonic seizures** in a woman with preeclampsia, which is a life-threatening obstetric emergency. - The patient described has no signs of seizures or even severe preeclampsia.

Question 9: Which of the following is advised for severe preeclampsia complicating cesarean delivery?

A. Epidural anesthesia (Correct Answer)
B. Local infiltration
C. Spinal anesthesia
D. Combined spinal-epidural anesthesia

Explanation: ***Epidural anesthesia*** - **Epidural anesthesia** allows for a **gradual decrease in sympathetic tone** and blood pressure, which is beneficial in severe preeclampsia to avoid rapid hemodynamic changes. - It also provides excellent postoperative analgesia and can be used for **blood pressure control** if needed. *Local infiltration* - **Local infiltration** provides inadequate surgical anesthesia for a cesarean delivery and would be insufficient for pain management. - It does not offer any systemic benefits or control over the hemodynamic instability often seen in severe preeclampsia. *Spinal anesthesia* - **Spinal anesthesia** is generally contraindicated in severe preeclampsia due to the risk of a **sudden and profound drop in blood pressure**, which can compromise placental perfusion and maternal vital signs. - The rapid onset and intense sympathetic blockade can lead to **uncontrolled hypotension**, which is dangerous given the already compromised cardiovascular status. *Combined spinal-epidural anesthesia* - While **combined spinal-epidural (CSE)** offers rapid onset (spinal component) and titratability (epidural component), the **spinal component still carries the risk of significant hypotension**, similar to spinal anesthesia alone. - The initial rapid drop in blood pressure from the spinal component can be detrimental in a patient with severe preeclampsia, despite the subsequent epidural control.

Question 10: A 32-year-old female at 36 weeks of pregnancy presents with BP 170/100 mmHg, visual disturbances, headache, urine protein 3+. What will be the next step?

A. IV labetalol and delivery at 37 weeks
B. IV labetalol, dexamethasone, and immediate termination of pregnancy
C. IV labetalol, dexamethasone, and conservative management
D. IV labetalol, magnesium sulfate (MgSO4), expedite delivery (Correct Answer)

Explanation: ***IV labetalol, magnesium sulfate (MgSO4), expedite delivery*** - The patient presents with **severe preeclampsia** (BP > 160/110 mmHg, visual disturbances, headache, proteinuria) at 36 weeks, requiring **antihypertensive therapy** (labetalol) and seizure prophylaxis (**magnesium sulfate**). - Given the severe features and gestational age, **expedited delivery** is indicated to prevent maternal and fetal complications, as expectant management beyond severe preeclampsia at this stage offers minimal benefit and increased risk. *IV labetalol and delivery at 37 weeks* - While IV labetalol is appropriate for **blood pressure control**, delaying delivery to 37 weeks might not be optimal given the **severe features of preeclampsia** at 36 weeks, increasing risks for both mother and fetus. - The plan is incomplete without mentioning **seizure prophylaxis** with magnesium sulfate, which is crucial for severe preeclampsia. *IV labetalol, dexamethasone, and immediate termination of pregnancy* - **Dexamethasone** is used for **fetal lung maturity** in preterm deliveries and is not indicated for immediate termination unless the fetus is preterm and lung maturity is a concern. At 36 weeks, lung maturity is usually established. - While immediate termination might be considered, the phrase "immediate termination" implies C-section without considering vaginal delivery and overlooks the need for **seizure prophylaxis**. *IV labetalol, dexamethasone, and conservative management* - **Dexamethasone** is not a primary treatment for severe preeclampsia itself but rather for **fetal lung maturation** in preterm deliveries, which is less critical at 36 weeks. - **Conservative management** is generally inappropriate for **severe preeclampsia** at 36 weeks, as it increases maternal and fetal risk; delivery is the definitive treatment.

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