HTN In Pregnancy Flashcards
Why it’s important to study about the HTN during pregnancy ?
Because it’s an a leading cause of maternal/fetal ad neonatal morbidity and mortality ….
Hemodynamic changes in normal pregnancy ?
1-Decrease the systemic vascular resistance ( due to progesterone )
2-cardiac output and plasma volume increase
3- physiological drop in the blood pressure before the first trimester due to vasodilation
The physiological drop in the blood pressure due to vasodilation happened in which trimester ?
End of first trimester
Definition of hypertension in pregnancy according to the American heart association
When the systolic is more than140 and diastolic is more than 90 on 2 occasions 4 hours apart
What is the definition of proteinuria according to the AHA ?
Presence of more than 300 mg of proteins in a 24 hours collection …
In pregnancy proteinuria the ratio between protein to creatinine is ?
More than 30 mg
We have 3 scenarios for a pregnant woman with hypertension ?
1- Diagnosed during the first 20 weeks or before pregnancy —-chronic hypertension/white coat
2- diagnosed after 20 weeks of pregnancy but without proteinuria or end organ damage -gestational
3- diagnosed after 20 weeks of gestation but with proteinuria and organ damage - preeclampsia
What is preeclampsia ?
Multi system syndrome developed after 20 weeks of gestation characterized by proteinuria ,end organ damage with hypertension
criteria of chronic hypertension ?
-diagnosed prior to 20 weeks of gestation
-persist for more than 12 weeks after pregnancy
- it’s more than 140/90 in mild hypertension
-more than 160/110 on the sever hypertension
The chronic hypertension is classified into 2 types ?
Primary (idiopathic)
Secondary due to -endocrine causes -cardiological & vascular causes
-renal causes
What are the renal causes that could lead to secondary chronic hypertension ?
-Polycystic kidney disease
-Glomerulonephritis
-Renal artery stenosis
Endocrine causes that leads to secondary chronic hypertension ?
Crushing syndrome
Conn’s syndrome
Cardiovascular causes that lead to secondary chronic hypertension ?
Coarctation of the aorta
HTN effects on the baby ?
Fetal growth restriction
Preterm birth
Perinatal mortality
Maternal Effects of hypertension ?
-preeclampsia (50%)
- placental abruption
- dic
-Death
-Over failure
-renal failure
What’s the effect of HTN on the mood of delivery?
It increase the risk of cesarean sections
Gestational hypertension is ?
Hypertension that is diagnosed after 20 weeks of pregnancy with no proteinuria or end organ damage .
It’s usually more than 10/90 2 readings 4 hours apart
What are the findings of maternal organ dysfunction in preeclampsia with the absence of proteinuria ?
Headache
Blurred vision
Epigastric pain
High liver enzymes
What is the early preeclampsia ? And what s the risk factors for it ?
When we have proteinuria and end organ failure before 20 weeks of gestation
-multiple gestation
-partial molar pregnancy
What is preeclampsia on a top of chronic hypertension ?
When we have history of hypertension before pregnancy but we have a history of complication (prouteinuria and maternal organ damage after 20 weeks of pregnancy
What are the maternal organ dysfunction of sever preeclampsia ?
Renal insufficiency
Hepatic dysfunction
Hematological complication (dic )
Pulmonary edema
Neurological complication (stoke ,sever headache ,hyperreflexia ,blindness )
What is the type of headache in preeclampsia patients ?
Occipital with hyperreflexia and increase risk of visual scotomata
What are the Investigations that should be done for the sever preeclampsia patients?
Blood pressure -160/110
LFT
Serum creatinine
Platelet count
Fetal investigation that should be done for a patient with severe preeclampsia?
CTG
US
The incidence of preeclampsia?
2-5% more in black women
What are he outcomes for preeclampsia when it comes to the time of delivery
1/3 -preterm preeclampsia
2/3 term preeclampsia
What are the maternal short term complication of preeclampsia?
1– eclampsia
2- blindness
3- liver failure
4-renal failure
5-pulmanory edema
6- death
7- DIC
8- HELP SYNDROME