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Charis & Ellie VS Reproduction > HT in pregnancy > Flashcards

HT in pregnancy Flashcards

1
Q

HT in pregnancy can be split into how many categories?

A

3
Pre-existing
Gestational/pregnancy induced
Pre-eclampsia

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2
Q

What is HT defined as in pregnancy?

A 
BP>140/90 on 2 occasions 
OR 
160/110 on 1 occasion
OR 
>30/15 mmHg compared to 1st trimester BP
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3
Q

What is the likely diagnosis if HT is present in early pregnancy and why?

A

Pre-existing HT

Because these diseases are usually of 2nd half of pregnancy if that is the cause

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4
Q

What does PE HT increase risk of?

A

Pre-eclampsia
Intra-uterine growth
Restriction
Abruption

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5
Q

What HT drugs are Teratogenic and should be stopped?

A

ACEis
ARBs
Diuretics

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6
Q

First line HT therapy during pregnancy?

A

Oral labetalol

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7
Q

What is orla labetalol?

A

Joint alpha and beta blocker

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8
Q

2nd line agents for HT in pregnancy?

A

Methyldopa

Nifedipine

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9
Q

Women who are at mod-high risk of -re-eclampsia should be given what and for how long/when?

A

Aspirin from 12 weeks until birth if moderate or high risk

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10
Q

Are HT drugs safe for breast feeding?

A

Yes- well some are
ACEi, B blockers and nifedipine are all safe

Methyldopa should be avoided

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11
Q

What drug should be avoided in Breast feeding and why?

A

Methyldopa

Risk of depression

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12
Q

Definition of gestational HT?

A

BP> 140/90mmHg after 20 weeks gestation in previously normotensive woman

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13
Q

When does gestational HT normally resolve?

A

6 weeks after delivery

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14
Q

Are there any other features accompanying gestational HT?

A

NO features of pre-eclampsia (Proteinuria)

although 15% do progress to pre-eclampsia

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15
Q

Rate of gestational HT recurrence?

A

High

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16
Q

Blood tests for gestational HT?

A 
-FBC 
U&Es 
-Serum creatinine 
-Calcium 
-Liver biochem
-LFTs
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17
Q

What should be tested for in urine in gestational HT?

A

Urine tests for protein to check for pre-eclampsia

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18
Q

Mod gestational HT treated with?

A

Oral labetalol

19
Q

When would a woman need admitted to hospital in gestational HT?

A

BP>160/110

20
Q

What is pre-eclampsia?

A

Condition seen after 20 weeks of pregnancy characterized by pregnancy induced HT and proteinuria and oedema

21
Q

Pathogenesis of pre-eclampsia?

A
  • Thought to be multifactorial (genetic&environment)
  • Stage 1: abnormal placental perfusion
  • Stage 2: maternal syndrome where mother responds to decreased placental perfusion and this = systemic disease
22
Q

Why does abnormal placental perfusion happen in stage 1 of pre-eclampsia?

A

Abnormal trophoblastic invasion

23
Q

Stage 2 causes what of pre-eclampsia?

A

Systemic disease

24
Q

RFs for developing pre-eclampsia?

A 
Age >40 
BMI> 30 
Fam Hx 
Multiple pregnancy 
Primiparity 
Previous Pre-eclamp
Long birth interval 
Molar pregnancy 
Pre-existing HT 
Renal disease 
Diabetes 
APS 
RA 
Sickle cell disease
25
Q

Presentation of pre-eclampsia? (symptoms)

A
  • Headache
  • visual disturbance
  • Epigastric pain/RUQ pain
  • N&V
  • Rapidly progressive oedema
26
Q

Signs of pre-eclampsia?

A 
HT 
Proteinuria 
Oedema 
Abdo tenderness 
Disorientation 
SGA 
Itra0uterine fetal death 
Hyper-reflexia/involuntary movements/clonus
27
Q

Investigations for pre-eclampsia?

A 
U&Es 
Serum urate 
LFTs 
FBCs 
Coag screen 
Urine creatinine ration 
Cardiotocography 
US 
Bilateral uterine notching on doppler US= rf for onset of pre-eclamp
28
Q

What is an investigation finding that is a RF for onset of pre-eclampsia?

A

Bilateral uterine notching on doppler US

29
Q

Management of pre-eclampsia when BP=140/90-159-109mmHg?

A

Admit if clinical concerns of well being
Offer drugs if BP remains above 140/90 (labetalol)
Aim for BP <135/85
BP monitor every 48 hours
Measure FBCs, LFT, Renal function 2 times week
Fetal heart auscultation
US at diagnosis and then every 2 weeks

30
Q

Treatment of pre-eclampsia where BP is >160/110?

A

Admit to hospital
Drugs for all women
BP 135/85 or less = target
Monitor BP every 15-35 mins until below 160/110
Measure FBCs, liver function, renal function 3 times a week
Fetal heart auscultation
US at diagnosis then every 2 weeks

31
Q

Only cure for pre-eclampsia?

A

Birth

32
Q

When to deliver baby in a mother with pre-eclampsia?

A

Most women delivered within 2 weeks of diagnosis

33
Q

Indications for birth include?

A 
Term gestation 
Inability to control BP 
Rapidly deteriorating biochem/haem 
Eclampsia 
Fetal compromise on US or CTG
34
Q

Crises in pre-eclmapsia?

A 
Eclampsia 
HELLP syndrome 
Pulmonary syndrome 
Placental abruption 
Cerebral haemorrhage 
Cortical blindness 
DIC 
Acute renal failure 
Hepatic rupture
35
Q

What is eclampsia?

A

Tonic clonic seizures occuring with feature of pre-eclampsia

36
Q

Management of eclampsia?

A

Control BP with IV labetalol or IV hydralazine
Stop/prevent seizures with magnesium sulphate
Fluid balance (PO= big cause of death therefore run ptnt dry)
Delivery aim for vaginal if possible

37
Q

What is HELLP Syndrome?

A

Haemolysis
Elevated liver enzymes
Low platelets

38
Q

Why is there haemolysis in HELLP syndorme?

A

Endothelial damage in pre-eclampsia results in formation of tiny thrombi which damage red cells as they circulate

39
Q

Clinical features of HELLP?

A

Patients complain of epigastric/RUQ pain, N&V, jaundice

40
Q

Treatment of HELLP?

A

Similar to pre-eclampsia

may also be given blood transfusions to treat anaemia and low platelets

41
Q

If symptoms are severe in HELLP what is advised?

A

Prompt delivery in patients who are beyond 34 weeks gestation

42
Q

Secondary prevention of Pre-eclampsia?

A

Low dose aspirin at 12 weeks gestation to reduce risk

43
Q

Why would secondary prevention be done>

A

Done in women with history of pre-eclampsia or risk of factors for pre-eclampsia

Charis & Ellie VS Reproduction (71 decks)

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