Hypertension and Pre-eclampsia Flashcards

1
Q

Definition

A

New high blood pressure (hypertension) in pregnancy with end-organ dysfunction, notably with proteinuria
= Occurs after 20 weeks gestation, when the spiral arteries of the placenta form abnormally, leading to a high vascular resistance in these vessels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pre-eclampsia triad

A
  • Hypertension
  • Proteinuria
  • Oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Chronic HTN definition

A

High blood pressure that exists before 20 weeks gestation and is longstanding.
- This is not caused by dysfunction in the placenta and is not classed as pre-eclampsia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pregnancy-induced hypertension/ gestational hypertension

A

Hypertension occurring after 20 weeks gestation, without proteinuria.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Eclampsia

A

When seizures occur as a result of pre-eclampsia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

High Risk factors

A
  • Pre-existing hypertension
  • Previous hypertension in pregnancy
  • Existing autoimmune conditions (e.g. systemic lupus erythematosus)
  • Diabetes
  • Chronic kidney disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Moderate Risk Factors

A
  • Older than 40
  • BMI > 35
  • More than 10 years since previous pregnancy
  • Multiple pregnancy
  • First pregnancy
  • Family history of pre-eclampsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pathophysiology

A
  • Poorly understood
  • When blastocyst implants on the outermost layer of endometrium (syncytiotrophoblast), and grows into it forming finger-like projections called chorionic villi containing fetal blood vessels.
  • Trophoblast invasion of the endometrium sends signals to the spiral arteries in the area of the endometrium, reducing their vascular resistance + making them more fragile = blood flow to these arteries increases = eventually breakdown leaving pools of blood (lacunae). Maternal blood flows from the uterine arteries into lacunae and back out through the uterine veins. lacunae form at around 20 weeks gestation.
    When the process of forming lacunae is inadequate, the women can develop pre-eclampsia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Effects on placenta due to pre-eclampsia

A

Poor perfusion of the placenta. This causes oxidative stress in the placenta, and the release of inflammatory chemicals into the systemic circulation, leading to systemic inflammation and impaired endothelial function in the blood vessels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Symptoms

A
  • Headache
  • Visual disturbance or blurriness
  • Nausea and vomiting
  • Upper abdominal or epigastric pain (this is due to liver swelling)
  • Oedema
  • Reduced urine output
  • Brisk reflexes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diagnosis

A
  • Systolic blood pressure above 140 mmHg
  • Diastolic blood pressure above 90 mmHg
    + any of:
    = Proteinuria (1+ or more on urine dipstick)
    = Organ dysfunction (e.g. raised creatinine, elevated liver enzymes, seizures, thrombocytopenia or haemolytic anaemia)
    = Placental dysfunction (e.g. fetal growth restriction or abnormal Doppler studies)
  • Proteinuria can be quantified using:
    = Urine protein:creatinine ratio (above 30mg/mmol is significant)
    = Urine albumin:creatinine ratio (above 8mg/mmol is significant)

Placental growth factor (PGIF) completed between 20 -35 weeks gestation = low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Prophylactic Treatment

A

Aspirin - given 12 weeks of gestation until birth to women with:
- A single high-risk factor
- Two or more moderate-risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Routine check up to check for pre-eclampsia

A

Blood pressure
Symptoms
Urine dipstick for proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Gestational hypertension (without proteinuria) management

A
  • Treating to aim for a blood pressure below 135/85 mmHg
  • Admission when BP < 160/110 mmHg
  • Urine dipstick testing at least weekly
  • Blood tests weekly (FBC, LFT and renal profile)
  • Monitoring fetal growth by serial growth scans
  • PlGF testing on one occasion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pre-eclampsia treatment

A

Similar to GH +
- Scoring systems used to determine whether to admit woemn (fullPIERS or PREP-S)
- Blood pressure is monitored closely (at least 48 hours)
- Urine dipstick weekly not necessary (Dx already made)
- USS. amniotic fluid and dopplers = two weekly to monitor fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Medical management

A

FIRST LINE = LABETOLOL (Anti hypertensive)
Second line = Nifedipine (modified-release)
Third line = Methyldopa (MUST be stopped within 48hrs of birth

17
Q

Acute treatment in critical care in severe pre-eclampsia or eclampsia

A

Intravenous hydralazine

18
Q

Medication given during labour and in the 24 hours afterwards to prevent seizures

A
  • IV magnesium sulphate
  • Fluid restriction is used during labour in severe pre-eclampsia or eclampsia, to avoid fluid overload
19
Q

Planned early birth

A

May be necessary if the blood pressure cannot be controlled or complications occur.
- Corticosteroids should be given to women having a premature birth to help mature the fetal lungs.

20
Q

After delivery care

A

Blood pressure is monitored closely = should return to normal after placenta removed
Medication:
- FIRST LINE = Enalapril
- FIRST LINE IN BLACK AFRICAN OR CARIBEAN Px = Nifedipine
THIRD LINE = Labetolol

21
Q

Eclampsia treatment

A

IV magnesium sulphate is used to manage seizures associated with pre-eclampsia.

22
Q

HELLP Syndrome

A

Complications of pre-eclampsia:
- Haemolysis
- Elevated Liver enzymes
- Low Platelets

23
Q

Complications

A

Significant cause of maternal and fetal morbidity and mortality.
- Without Tx can lead to:
= maternal organ damage,
= fetal growth restriction,
= seizures,
= early labour
= small proportion is death.