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Preeclampsia: A PLAB 2 Clinical Approach for Safe and Effective OSCE Practice

Updated: Jul 18

🔍 Overview

Preeclampsia is a multi-system hypertensive disorder of pregnancy, diagnosed after 20 weeks gestation, characterised by:

  • New-onset hypertension

  • Proteinuria

  • ± signs of end-organ dysfunction

It’s a high-yield topic in PLAB 2 because of its seriousness, the need for structured communication, and the emphasis on maternal and fetal safety.



🧠 Layman Explanation (for Patient Communication in OSCE)

“Preeclampsia is a condition in pregnancy where your blood pressure becomes high and there's protein leaking into your urine. It’s caused by the placenta not developing properly, and if not treated, it can affect your organs and your baby’s growth. But we monitor and treat it carefully to keep both you and your baby safe.”

📅 Onset and Detection

  • Occurs after 20 weeks gestation

  • Most common between 32–37 weeks, but can appear anytime in the second half of pregnancy or even after delivery

  • Often picked up at routine antenatal appointments with BP and urine checks


⚠️ Signs and Symptoms (Ask for in History)

Maternal Symptoms

Fetal Concerns

Headache, visual changes

Decreased fetal movements

Epigastric or RUQ pain

Poor growth (IUGR)

Swelling (face, hands)

Abnormal CTG findings

Sudden weight gain


Nausea, vomiting


Red flag: Seizure = eclampsiaRed flag: RUQ pain + low platelets = HELLP syndrome


🩺 Risk Factors (Ask in History)

  • First pregnancy

  • Twin pregnancy

  • Age >40

  • Pre-existing HTN, diabetes, kidney disease

  • Family history of preeclampsia

  • Previous preeclampsia

  • Autoimmune disease (e.g., SLE, antiphospholipid syndrome)

  • Obesity (BMI >35)


✅ Diagnostic Criteria

BP ≥140/90 mmHg on 2 readings (≥4 hrs apart)PLUS one of the following:

  • Proteinuria ≥+1 on dipstick or PCR >30 mg/mmol

  • Thrombocytopenia (<100,000)

  • Impaired liver function (↑AST/ALT)

  • Renal impairment (↑creatinine)

  • Pulmonary edema

  • Neurological symptoms (e.g., headache, clonus)



🧪 Investigations at 38 Weeks with High BP and Proteinuria

Test

Purpose

FBC

Platelets (for HELLP)

LFTs

Liver damage

Urea, Creatinine, Electrolytes

Kidney function

Coagulation profile

Safe for delivery

LDH

Hemolysis marker

Urine PCR / 24h collection

Confirm proteinuria

CTG

Assess fetal wellbeing

Reflexes, clonus, visual symptoms

Rule out risk of eclampsia

Urine output (hourly)

Monitor renal perfusion


🚨 Complications (Explain in Layman Terms)

“If not treated, preeclampsia can cause seizures (called eclampsia), liver or kidney problems (called HELLP syndrome), or problems with your baby’s growth. That’s why we keep a close watch and may need to deliver the baby when it’s safest.”

Maternal

Fetal

Eclampsia (seizures)

IUGR (growth restriction)

HELLP syndrome

Fetal distress

Stroke / organ failure

Placental abruption

Pulmonary edema

Stillbirth (if unmanaged)



📦 Immediate Management at 38 Weeks

At 38 weeks, the definitive management is delivery, since the baby is full term.


🔧 Before Delivery:

  • Labetalol/Nifedipine to control BP

  • Magnesium sulfate IV to prevent seizures

  • Monitor urine output hourly via catheter if needed

  • CTG and fetal wellbeing checks


👶 If the Baby’s Head is Engaged

If the baby’s head is already engaged (in the pelvis), vaginal delivery is preferred provided:

  • BP is controlled

  • No signs of eclampsia or HELLP

  • Labor is progressing

  • Fetal monitoring is reassuring



❗ C-section may be needed if:

  • Severe or uncontrolled hypertension

  • Fetal distress on CTG

  • Failed induction

  • Maternal deterioration

  • Previous uterine surgery


🛡️ How to Prevent Complications

  • Attend antenatal visits regularly

  • Monitor symptoms at home (headaches, blurred vision, swelling)

  • Report reduced fetal movements

  • If high-risk, start low-dose aspirin from 12–16 weeks until 36 weeks


🗣️ PLAB 2 Consultation Tips

  • Use simple, non-scary language

  • Acknowledge the mother’s concerns:“It’s completely understandable to feel worried. We’re here to monitor you closely and take action if needed to keep you and your baby safe.”

  • Always safety net:“If you experience headache, blurry vision, tummy pain, or notice less baby movement—please come to the hospital immediately.”

  • Mention follow-up postpartum as preeclampsia may continue or worsen after birth



🧾 In Summary

Step

Action

Diagnosis

High BP + proteinuria after 20 weeks

Monitor

Bloods, urine, fetal heart, symptoms

Stabilise

Antihypertensives, magnesium

Deliver

If 37+ weeks, usually proceed to delivery

Route of delivery

Vaginal if safe, C-section if complications

📚 References:

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