4: Hypertension in pregnancy Flashcards Preview

Reproduction Week 4 2018/19 > 4: Hypertension in pregnancy > Flashcards

Flashcards in 4: Hypertension in pregnancy Deck (42)
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1

Hypertension can ___ by pregnancy.

induced

due to cardiovascular changes in mother

2

What is the spectrum of disorders caused by hypertension in pregnancy?

Pregnancy-induced hypertension > Pre-eclampsia > Eclampsia

3

What is the fatal end-point of uncontrolled hypertension in pregnant women?

Eclampsia

4

What percentage of pregnant women suffer from hypertension?

10 - 15%

5

What cardiovascular changes occur in pregnancy?

HR, SV, contractility and CO INCREASE

BP and TPR DECREASE

6

How does blood pressure change during the course of pregnancy?

Initially drops

Then increases gradually until term

Same pattern post-birth

7

What blood pressure reading is required to diagnose a pregnant woman with hypertension?

> 140 / 90 on two occasions

> 160 / 110 once

8

In which trimester does pregnancy-induced hypertension tend to develop?

2nd trimester

9

If a pregnant woman develops hypertension before the 2nd trimester, what should you suspect?

Pre-existing hypertension

10

What is the course of pregnancy-induced hypertension?

Persists throughout pregnancy, then resolves 6 weeks post-birth

11

Does pregnancy-induced hypertension feature any other symptoms as in pre-eclampsia?

No

12

What is the triad of signs seen in pre-eclampsia?

Hypertension

Proteinuria

Oedema

13

What is pre-eclampsia?

A multi-system disorder developing in pregnant women and their foetuses due to widespread epithelial dysfunction

Presents as hypertension, proteinuria and oedema

14

In which trimester of pregnancy does pre-eclampsia present?

2nd trimester

15

What is the pathogenesis of pre-eclampsia?

Spiral arteries of placenta become compressed

Blood flow through tight arteries causes epithelial damage

Thrombosis --> Placental ischaemia

Toxins circulate throughout the body, causing widespread organ dysfunction

16

Which process is blocked in pre-eclampsia, causing widespread damage?

Angiogenesis

17

Why are toxins released from the placenta in pre-eclampsia?

Compression of spiral arteries causes endothelial damage, thrombosis and placenta ischaemia

18

The toxins released by the placenta in pre-eclampsia damage the ___ of other systems.

vasculature

19

What effects does pre-eclampsia have on the renal system?

Proteinuria

Reduced renal function (manifesting as decreased eGFR and urine output)

20

What effect does eclampsia (untreated pre-eclampsia) have on the CNS?

Seizures

Cerebral oedema

Cranial nerve palsy

Coma

21

What is a rare variant of pre-eclampsia caused by liver dysfunction?

HELLP syndrome

haemolysis, elevated liver enzymes, low platelets

22

HELLP syndrome is a variant of pre-eclampsia caused by damage to which organ?

What are the signs?

Liver

Haemolysis, elevated liver enzymes, low platelets

23

Where is pain felt in liver disease?

Epigastric region

Right upper quadrant

can refer to the right shoulder

24

What are some respiratory complications of pre-eclampsia?

Pulmonary oedema

Pulmonary embolism

25

The signs of pre-eclampsia are hypertension, proteinuria and oedema.

What are the symptoms?

Headache

Visual disturbance

Abdominal pain

N&V

Oedema

26

The foetus of a mother with untreated pre-eclampsia will be (small / large) for dates.

small for dates

27

Does eclampsia present with upper or lower motor neuron signs?

What are they?

UMN signs

Hyperreflexia, clonus

Followed by seizures and death

28

Keeping in mind the organs which are damaged by pre-eclampsia, what investigations would you do for it?

BP

Renal function - U&Es, eGFR, creatinine

Liver function tests

Foetal - ultrasound, CTG

29

What specific ultrasound scan can be done for pre-eclampsia?

Uterine artery doppler

Low flow and high resistance are signs of pre-eclampsia

30

What is the only definitive treatment for pre-eclampsia?

Delivery