Complications of Pregnancy 2 Flashcards
(41 cards)
Define chronic hypertension
HTN either pre-pregnancy or at booking (<20weeks or 20 weeks)
I.e. she’s had it before the pregnancy and they’ve just noticed now
Define mild HTN
Diastolic 90-99, systolic 140-149
Define moderate HTN
Diastolic 100-109 systolic 150-159
Define severe HTN
Diastolic >110, systolic >160
Define gestational hypertension
New HTN in pregnancy developing after 20 weeks
Define pre-eclampsia
Significant new HTN + significant proteinuria
What is significant proteinuria defined as?
Automated reagent strip urine protein estimation >1+
Spot urinary protein: creatinine ratio >30mg/mmol
24h urine protein collection >300mg/day
In which group of mothers is chronic HTN more common?
Older mothers
What anti-HTN can you not use in pregnancy?
ACEi - small risk of birth defects/impaired growth
ARBs
Antiduretics (risk of dehydration
Give two e.g.s of ACEis
Rampiril, enalopril
Give two e.g.s of ARBs
Losartan, candesartan
What is involved in the management of essential HTN in pregnancy?
Lower dietary Na
Aim for BP <150/100
Best anti-HTN drugs to use: labetabolo, nifedipine, methyldopa
Monitor for super-imposed pre-eclampsia
Monitor foetal growth
Watch out for placental abruption (higher risk)
What is the proper definition for pre-eclampsia diagnosis?
Mild HT on two occasions more than 4h apart or moderate-severe HT (one reading) AND proteinuria of more than 300mgms/24h (protein urine >+1 + protein:creatnine ratio >30mgms/mmol)
What systems does PET affect?
Multi-system disorder
Affects kidneys, liver, vascular, cerebral and pulmonary systems
What is the pathophysiology of PET?
Trophoblast invasion of spinal arterioles impaired –> placental/foetal hypoperfusion
Poorly perfused placenta releases pro-inflammatory proteins –> enter mum’s circulation and cause endothelium lining mum’s BVs to become dysfunction –> vasoconstriction
Imbalance between vasodilators (prostacyclin) and vasoconstrictors (thromboxane)
Endothelial cell dysfunction also affects kidneys causing them to retain more salt
Both –> HTN
Also localised area of vasospasm in mother’s BVs which can lead to reduced BF to certain organs
Endothelial cell dysfunction leads to BVs becoming more likely --> loss of protein from urine and increased water loss from vessels into tissues --> Generalised oedema (legs, hands, face) Pulmonary oedema (cough, SoB) Cerebral oedema (headaches, confusion, seizures (eclampsia))
In PET, there is vasospasm in the mother’s BVs which may lead to reduced BF to certain organs, give e.g.s of the effects of these
Kidneys –> glomerular damage –> oliguria & proteinuria
Retina –> blurred vision, flashing flights, scotoma
Liver –> injury and swelling –> elevation of liver enzymes, stretching of capsule –> RUQ pain (cardinal sign of severe pre-eclampsia)
What happens to the spiral arteries in pregnancy?
They are converted into the uteroplacental BF
They lose their smooth muscle and dilate by 5-10x
What are risk factors for developing PET?
First pregnancy Extremes of maternal age Pre-eclampsia in previous pregnancy Pregnancy interval >10y BMI >35 FH of PET Multiple pregnancy Underlying medical disorder (chronic HTN, pre-existing renal dx, pre-existing DM, autoimmune disorders (e.g. SLE)
What are the complications of PET?
High BP –> haemorrhagic stroke/placental abruption
Renal failure
Pulmonary/cardiac failure (never fluid overload these patients!)
HELLP
Eclampsia
Impaired placental perfusion –> IUGR, foetal distress, prematurity
What is HELLP?
Endothelial injury –> formation of tiny thrombi in microvasculature which uses up lots of platelets
Clots are hazardous to RBCs –> haemolysis
HELLP = haemolysis, elevated liver enzymes, low platelets
HELLP occurs in severe PET
What is eclampsia?
Pre-eclampsia + seizures
What are signs and symptoms of severe PET?
Headache, blurring of vision, epigastric pain, pain below ribs, vomiting, sudden swelling of hands/face/legs
Severe HTN >3+ urine proteinuria
Clonus/brisk reflexes, papilloedema, epigastric tenderness
Oligouria
Convulsions (eclampsia)
What biochemical abnormalities might you get in severe PET?
Raised liver enzymes, bilirubin if HELLP present
Raised urea & creatinine, raised urate
Low platelets, Hb
Features of DIC
How do you manage severe PET?
Frequent BP & urine protein checks
Check for symptoms/hyper-reflexia, tenderness over liver
Blood investigations - FBC, LFTs, renal function tests (serum urea, creatinine, urate), coagulation tests
Foetal investigations - scan for growth, CTG
Only cure is delivery of baby and placenta - consider induction if foetal/maternal condition deteriorates
