Complications of Pregnancy 2 Flashcards
(37 cards)
Define chronic hypertension in terms of pregnancy
Hypertension existing pre-pregnancy or at booking (= 20 weeks gestation)
Define mild, moderate and severe hypertension
- Mild, 140-149/90-99
- Moderate, 150-159/100-109
- Severe, 160 or > / 110 or greater
2 hypertensive disorders in pregnancy
- Gestational hypertension (AKA pregnancy induced hypertension PIH),
- Pre-eclampsia
Define gestational hypertension and pre-eclampsia
- Gestational hypertension, Hypertension that develops after 20 weeks of pregnancy (categorised as mild, moderate or severe)
- Pre-eclampsia, Hypertension that develops after 20 weeks + significant proteinuria
3 ways of confirming significant proteinuria
- Dipstick test: Urine protein estimation >1+
- Spot urinary protein: Creatinine ratio >30 mg/mmol
- 24hrs urine protein collection >300 mg/day
A risk factor for chronic hypertension in pregnancy
Older mothers
Aim of BP in patients with chronic hypertension in pregnancy
<150/100
Treatment for chronic hypertension in pregnancy
- Beta-blockers (Labetalol)
- Calcium channel blocker (Nifedipine)
- Centrally acting antihypertensive drugs (Methyldopa)
What should be monitored during the a pregnancy with chronic hypertension
Foetal growth
What does chronic hypertension increase the risk of
Placental abruption
Criteria to diagnose pre-eclampsia
-Proteinuria (>300mg/24hrs or creatinine ratio >30mg/mmol or dipstick protein estimation >1+
-Mild HT on 2 occasions more than 4hrs apart
or Moderate to severe HT
Pathophysiology of pre-eclampsia
- Secondary invasion of maternal spiral arterioles by trophoblast impaired, leading to reduced placental perfusion
- Imbalance between vasodilators/vasoconstrictors in pregnancy
Immunological and a genetic disposition
Risk factors for pre-eclampsia
- First pregnancy
- Extremes of maternal age
- Ore-eclampsia in previous pregnancy
- BMI >35
- Multiple pregnancy
- FHx of pre-eclampsia
- Chronic hypertension
- Renal disease
- Pre-existing diabetes
- Autoimmune disorders (SLE, antiphospholipid antibodies)
6 maternal complications of pre-eclampsia
- Eclampsia (seizures)
- Stroke
- HELLP (haemolysis, Elevated liver enzymes, low platelets)
- DIC (disseminated intravascular coagulation)
- Pulmonary oedema
- Cardiac + renal failure
5 foetal complications of pre-eclampsia
Impaired placental perfusion leading to;
- IUGR (Intrauterine Growth Restriction)
- Foetal distress
- Prematurity
- Increased PN (?perinatal?) mortality
Symptoms of pre-eclampsia
- Headache + blurred vision
- Vomiting + epigastric pain and tenderness
- Sudden swelling in face + hands
- Severe hypertension + papillodema
- Reducing urine output + >3+ proteinuria
- Clonus/brisk reflexes + seizures (eclampsia)
- Tenderness over liver
Biochemical abnormalities of pre-eclampsia
- Raised liver enzymes
- Raised urea and creatinine
- Raised urate
Haematological abnormalities of pre-eclampsia
- Low platelets
- Low haemoglobin, signs of haemolysis
- Features of DIC
Management of pre-eclampsia
- Frequent BP checks + urine protein
- Check symptomatology: headaches, epigastric pain, visual disturbances
- Check for hyper-reflexia + tenderness over liver
- Blood investigations
- Foetal investigations
What investigations would be carried in pre-eclampsia
- Blood investigations: FBC (for haemolysis), LFT’s, Renal function tests (serum urea, creatinine, urate), coagulation test if indicated
- Foetal investigation: Scan for growth + Cardiotocography (CTG)
What would be considered if maternal or foetal condition deteriorates during pre-eclampsia and why
Induction of labour, regardless of gestation, as the only cure for pre-eclampsia is delivery
When would steroids be given to mature foetal lungs for pre-term delivery
<36 weeks gestation
Treatment of eclamptic seizures
Magnesium sulphate bolus + IV infusion
Prophylaxis for pre-eclampsia in subsequent pregnancies
Low dose aspirin, from 12 weeks till delivery
