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Reproduction and Sexual Health > hypertension in pregnancy > Flashcards

hypertension in pregnancy Flashcards

1
Q

hypertension in pregnancy is defined as what?

A

> 140/90mmHg on 2 occasions or
160/110mmHg

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2
Q

3 types of hypertension?

A
  • pre-existing/chronic hypertension
  • gestational hypertension
  • pre-eclampsia
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3
Q

if women comes into booking appointment with hypertension what is she considered to have?

A
  • chronic hypertension
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4
Q

what secondary causes can you consider in hypertension presenting for the first time?

A
  • renal/cardiac
  • cushing’s
  • conn’s
  • phaeochromocytoma
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5
Q

risks of hypertension in pregnancy?

A
  • PET 2x
  • fetal growth restriction
  • abruption
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6
Q

what cardiac medications are women recommended to avoid while trying to get pregnant?

A
  • ACE
  • ARB
  • thiazide diuretics
    > teratogenics
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7
Q

what is gestational hypertension?

A
  • hypertension seen in second half of pregnancy and resolves 6/52 of delivery
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8
Q

how many women w gestational hypertension can progress on to pre-eclampsia

A
  • 15%
  • depends on gestation
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9
Q

Mx for chronic/GH

A
  • timing of birth dependent on clinical condition
  • aim to deliver women > 37 weeks
  • monitor BP daily after birth
  • aim to keep BP < 130/80
  • continue antihypertensives - review 2 weeks post natal by GP
  • further review 6-8 weeks post natal
  • stop methyl dopa within 2 days
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10
Q

what is pre-eclampsia?

A
  • pregnancy specific multi system disorder
  • may be asymptomatic at time of first presentation
  • diffuse vascular endothelial dysfunction widespread circulatory disturbance
  • renal/hepatic/CV/haem/CNS/placenta
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11
Q

pre-eclampsia clinical signs

A
  • hypertension
  • proteinuria (UPCR >30mg/mmol)
  • oedema
  • absence does not exclude diagnosis
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12
Q

early pre-eclampsia is before when?

A

< 34 weeks

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13
Q

late pre-eclampsia is when?

A

> 34 weeks
- 9/10 women present with late pre-eclampsia vs early pre-eclampsia

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14
Q

does pre-eclampsia have genetic or environmental predisposition?

A
  • yes - if in family more likely to get it
  • risk inc 3x if mother of sister has PET
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15
Q

what are 2 stages in pathogenesis of pre-eclampsia?

A
  • abnormal placental perfusion
    placental ischaemia
  • stage 2 - maternal syndrome
    anti-angiogenic state assoc w endothelial dysfunction
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16
Q

describe process of trophoblast invasion during pregnancy

A
  • trophoblast invasion from placenta into spiral artery
  • loss of muscle layer of spiral artery
  • more blood flow/nutrition/blood going to baby
    > failure of trophoblast invasion - endothelial damage - platelet aggregation - placental ischaemia and infarction - causing hypertension
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17
Q

HELLP syndrome stands for what?

A
  • haemolysis
  • elevated liver enzymes
  • low platelets

has a high morbidity/mortality

18
Q

how does liver disease related to pre-eclampsia present?

A

epigastric/RUQ pain
abnormal liver enzymes
hepatic capsule rupture

19
Q

symptoms of pre-eclampsia?

A
  • headache
  • visual disturbance
  • epigastric/RUQ pain
  • nausea/vomiting
  • rapidly progressive oedema
  • lack of fetal movement
20
Q

signs of pre-eclampsia

A
  • hypertension
  • proteinuria
  • oedema
  • abdominal tenderness
  • disorientation
  • small for gestational age fetus
  • intrauterine fetal death
  • hyper-reflexia/involuntary movements/clonus (check CNS)
21
Q

investigations for pre-eclampsia?

A
  • U+Es
  • serum urate
  • liver function tests
  • FBC
  • coagulation screen -> DIC
  • urine protein creatinine ratio (UPCR)
  • carditocography
  • US - fetal assessment
22
Q

women at high risk of PET are?

A
  • hypertensive during px pregnancy
  • CKD
  • AI - SLE or APS
  • type 1 or 2 DM
  • chronic hypertension
    > recommend 75-100mg aspirin daily from 12 weeks until birth of baby
23
Q

moderate risk factors of pre-eclampsia

A
  • nulliparity
  • > 40
  • interval between pregnancies of more than 10 years
  • BMI of 35 or more at first visit
  • FH of pre-eclampsia
  • 1 or more also given aspirin
24
Q

in tayside how much low dose aspirin is given to women with high risk/ 1 or more mod risk factors for pre-eclampsia?

A
  • 150mg dose from 12 weeks
25
Q

how can you predict pre-eclamspia?

A
  • using maternal uterine artery doppler
  • done at 20-24 weeks
26
Q

treatment of hypertension?

A
  • continue antihypertensives unless SBP <110 or DBP < 70
  • offer tx to women not on tx if SBP >140 or DBP >90
  • target BP = 135/85
  • risk of cerebral haemorrhage if MAP >150
  • BP >170/110 requires immediate tx
27
Q

what medications can you give women in tx of hypertension

A
  • methyldopa (a-agonist) 250mg/bd
  • labetolol (a and B agonist) 100mg/bd
  • nifedipine (Ca channel antagonist) SR 10mg/bd

2nd line
- hydralazine
- doxazocin

28
Q

CI to methyldopa?

A
  • depression
29
Q

CI to labetolol?

A
  • asthma
30
Q

which anti-hypertensives not safe to take while breast feeding?

A
  • doxazocin
31
Q

fetal surveillance in mother with hypertension/pre-eclampsia risk

A
  • fetal movements
  • CTG - daily
  • US - biometry, amniotic fluid index, umbilical artery doppler (AEDF, REDF)
32
Q

when to admit to hospital?

A
  • SBP > 160mmHg or high
  • creatinine >90
  • ALT > 70
  • platelet count < 150
  • signs of impending eclampsia
  • signs of impending pulmonary oedema
  • other signs of severe pre-eclampsia
  • suspected fetal compromise
33
Q

when to deliver baby?

A
  • only cure for pre-eclampsia is birth
  • mother must be stabilised first
  • consider expectant mx if pre-term
  • steroids/mag sulphate
  • mode dependent on gestation, parity, maternal/fetal condition
34
Q

indications for birth

A
  • term gestation - deliver within 24-48 hrs
  • inability to control BP
  • rapidly deteriorating biochemistry/haematology (pulse oximetry less than 90%)
  • eclampsia
  • pulmonary oedema
  • placental abruption
  • fetal compromise - abnormal US or CTG
  • still birth
35
Q

crises in pre eclampsia

A
36
Q

what is eclampsia?

A
  • tonic clonic (grand mal) seizure occuring w features of pre-eclampsia
  • can occur ante-partum/intra-partum/post partum
  • more common in teenagers
  • assoc w ischaemia/vasospasm
37
Q

mx of severe PET/eclampsia?

A
  • control BP
  • stop/prevent seizures
  • fluid balance
  • delivery
  • IV labetolol
  • IV hydralazine (2nd line)
    > beware hypotension - fetoplacental unit
38
Q

seizure tx/prophylaxis

A

magnesium sulphate
loading dose: 4g IV over 5-15 mins
maintenance dose: IV infusion 1g/h
further seizures give: 2-4g Mg SO4
administer for 24 hrs

39
Q

labour and birth

A
  • aim for vaginal birth if possible
  • control BP
  • epidural anaesthesia
  • continuous electronic fetal monitoring
  • avoid erogemtrine
  • caution with IV fluids - restrict input to 80ml/hr
40
Q

post-partum mx

A
  • BP monitoring
  • antihypertensives
  • bloods
  • breast feeding
  • contraception
  • urinalysis 6-8 weeks
  • counselling/debrief - recurrence
  • consider long term CV risk

Reproduction and Sexual Health (29 decks)

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