PRE-ECLAMPSIA AND ECLAMPSIA

 

In the acute setting, an initial assessment with cardiotocography should be undertaken. This gives information about fetal wellbeing at that time but does not give any predictive information. Women in labour with severe pre-eclampsia should have continuous electronic fetal monitoring. Cardiotocography (non-stress test) is the mainstay of fetal monitoring in most units. It can be repeated regularly and easily without need of expensive equipment or highly skilled personnel. It gives information concerning fetal wellbeing at that time but has little predictive value. If the woman is in labour, then continuous electronic fetal monitoring is appropriate.^GT8

If conservative management is planned then further assessment of the fetus with ultrasound measurements of fetal size, umbilical artery Doppler and liquor volume should be undertaken. Serial assessment will allow timing of delivery to be optimised. The main pathology affecting the fetus, apart from prematurity, is placental insufficiency leading to intrauterine growth restriction (IUGR). IUGR occurs in around 30% of pre-eclamptic pregnancies.Ultrasound assessment of fetal size, at the time of the initial presentation with hypertension, is a valuable one-off measurement to assess fetal growth. Growth restriction is usually asymmetrical so measurement of the abdominal circumference is the best method of assessment.Reduced liquor volume is also associated with placental insufficiency and fetal growth restriction. Serial estimations of liquor volume can detect fetal compromise. Randomised trials have shown that investigation with umbilical artery.

The value of Doppler in other fetal vessels has yet to be clarified. Doppler assessment, using absent or reversed-end diastolic flow, improves neonatal outcome⁰⁰⁰¹ and serial investigations of this and other fetal vessels can be used to follow pregnancies under treatment and optimise delivery.