Hypertension can ___ by pregnancy.
due to cardiovascular changes in mother
What is the spectrum of disorders caused by hypertension in pregnancy?
Pregnancy-induced hypertension > Pre-eclampsia > Eclampsia
What is the fatal end-point of uncontrolled hypertension in pregnant women?
What percentage of pregnant women suffer from hypertension?
10 - 15%
What cardiovascular changes occur in pregnancy?
HR, SV, contractility and CO INCREASE
BP and TPR DECREASE
How does blood pressure change during the course of pregnancy?
Then increases gradually until term
Same pattern post-birth
What blood pressure reading is required to diagnose a pregnant woman with hypertension?
> 140 / 90 on two occasions
> 160 / 110 once
In which trimester does pregnancy-induced hypertension tend to develop?
If a pregnant woman develops hypertension before the 2nd trimester, what should you suspect?
What is the course of pregnancy-induced hypertension?
Persists throughout pregnancy, then resolves 6 weeks post-birth
Does pregnancy-induced hypertension feature any other symptoms as in pre-eclampsia?
What is the triad of signs seen in pre-eclampsia?
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
In which trimester of pregnancy does pre-eclampsia present?
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
Which process is blocked in pre-eclampsia, causing widespread damage?
Why are toxins released from the placenta in pre-eclampsia?
Compression of spiral arteries causes endothelial damage, thrombosis and placenta ischaemia
The toxins released by the placenta in pre-eclampsia damage the ___ of other systems.
What effects does pre-eclampsia have on the renal system?
Reduced renal function (manifesting as decreased eGFR and urine output)
What effect does eclampsia (untreated pre-eclampsia) have on the CNS?
Cranial nerve palsy
What is a rare variant of pre-eclampsia caused by liver dysfunction?
haemolysis, elevated liver enzymes, low platelets
HELLP syndrome is a variant of pre-eclampsia caused by damage to which organ?
What are the signs?
Haemolysis, elevated liver enzymes, low platelets
Where is pain felt in liver disease?
Right upper quadrant
can refer to the right shoulder
What are some respiratory complications of pre-eclampsia?
The signs of pre-eclampsia are hypertension, proteinuria and oedema.
What are the symptoms?
The foetus of a mother with untreated pre-eclampsia will be (small / large) for dates.
small for dates
Does eclampsia present with upper or lower motor neuron signs?
What are they?
Followed by seizures and death
Keeping in mind the organs which are damaged by pre-eclampsia, what investigations would you do for it?
Renal function - U&Es, eGFR, creatinine
Liver function tests
Foetal - ultrasound, CTG
What specific ultrasound scan can be done for pre-eclampsia?
Uterine artery doppler
Low flow and high resistance are signs of pre-eclampsia
What is the only definitive treatment for pre-eclampsia?