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Obg Practicals > Hypertension > Flashcards

Hypertension Flashcards

(47 cards)

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1
Q

Grading of Oedema

A

Grade 1- mild : both feet /ankle
Grade 2- moderate: both feet plus ll, hands and arms
Grade 3- severe generalized , bl pitting edema including feet, ll, hands and arms, abdominal wall face
Grade 4- anasarca

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2
Q

Define gestational htn

A

Bp 140/90 or more occurring for the first time after 20 w of pregnancy in a previous normotensive woman without proteinuria, blood pressure will come to normal within 12 w of delivery

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3
Q

Risk factors for pre- eclampsia

A

Primi gravida
maternal age more than 35
Obesity
Multiple pregnancy
Vesicular mole
APLA

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4
Q

Mean arterial pressure and it’s importance

A

Systolic+( diastolic ×2)/ 3
If above 90mmhg in 2nd trimester predicts pre eclampsia
More than 105 diagnostic

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5
Q

Gallant’s roll over test

A

Done at 28-30weeks, increase diastolic BP >20mmhg when patient lies in supine position from left lateral position

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6
Q

Differentiating features between mild and severe pre- eclampsia

A

Mild- 140/90, with proteinuria 1+
Severe - >160/110, Headache, visual disturbances and vomiting
Proteinuria>3g/24h , oliguria, HELLP, Fundus grade 3 and 4

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7
Q

Anti hypertensive drugs used in pregnancy

A

Labetalol, nifidipine, alpha methyl dopa and hydralazine

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8
Q

What is the management approach for severe pre-eclampsia?

A

Admit in a high dependency unit for monitoring and stabilise the blood pressure with anti-hypertensive drugs

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9
Q

What is the management approach for mild pre-eclampsia?

A

Admit and investigate; ambulatory treatment is given with frequent antenatal visits

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10
Q

What parameters should be monitored in pre-eclampsia management?

A

BP frequently, daily urine albumin, maintain intake and output chart and monitor urine output

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11
Q

What position should a patient with pre-eclampsia rest in?

A

Left lateral position, 8 hours at night, 2 hours at daytime

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12
Q

How is fetal well-being monitored in pre-eclampsia?

A

Kick chart daily and modified biophysical profile (NST + AFI) biweekly

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13
Q

What dietary recommendations are made for pre-eclampsia management?

A

Avoid excess salt, advise high-protein diet

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14
Q

What should be done if blood pressure is not controlled with rest in pre-eclampsia?

A

Start anti-hypertensive drug

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15
Q

What indicates the need for Doppler ultrasound of fetal vessels?

A

Non-reactive NST, fetal growth restriction, reduced AFI, or oligohydramnios

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16
Q

When should hospitalization occur in pre-eclampsia management?

A

If any imminent symptoms occur

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17
Q

What medications are given in a hypertensive crisis if blood pressure is not controlled?

A

Parenteral labetalol or hydralazine, and administer MgSO4

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18
Q

What is the management at term if there are no maternal or fetal complications?

A

Induction at term

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19
Q

What is the protocol for managing severe pre-eclampsia between 34-37 weeks?

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A

If BP is under control and the patient is stable, continue pregnancy up to 37 weeks under careful monitoring; if not, deliver her

20
Q

What should be administered for acceleration of fetal lung maturity?

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A

Corticosteroids

21
Q

What should be done if the cervix is not favorable for induction?

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A

Ripen the cervix with PGE2alpha-0.5 mg (applied intra-cervical)

22
Q

What should be done when blood pressure is not controlled or maternal condition deteriorates?

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A

Termination of pregnancy

23
Q

What is done to augment labor in pre-eclampsia management?

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A

Augmentation of labor is done with oxytocin

24
Q

How is the progress of labor assessed during pre-eclampsia management?

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A

Monitor with CTG, progress assessed with partograph

25
What intervention may be used to cut short the second stage of labor?
Forceps or vacuum
26
What should be avoided during labor augmentation in pre-eclampsia?
IV ergometrine
27
Uses of MgSO4
Acts at the motor end plate and suppresses the acetylcholine release and sensitivity • in preterm as a tocolytic • in severe pre eclampsia - as a prophylaxis against eclampsia • in eclampsia, it reduces cerebral oedema and has anticonvulsant action
28
What is prichard's regimen
To administer MgSO4 Each ampoule has 2ml of 50% solution equivalent to 1g of MgSO4 Loading dose -4g of 20% MgSO4, given slowly IV over a period of 3-5 mins Followed by 5g of MgSO4 in each buttock Then on alternate buttock every 4h depending upon the bp, clinical and biochemical Continue till 24hrs of last fit or delivery
29
How to check for MgSO4 toxicity ?
Monitor for knee jerk, rr>16, uo>30 ml/h Therapeutic level 4-7mEq/l Antidote: calcium gluconate
30
Zuspan regime
4g MgSO4 as a bolus over 10 mins followed by 1g iv till 24
31
Complications of pre-eclampsia
Eclampsia, preterm, abruption placenta, oliguria, papilledema, hellp syndrome, cerebral haemorrhage
32
HELLP
Haemolysis, elevated liver enzymes, low platelet count
33
Couvelaire uterus
In abruptio placenta - extravasation of blood into the uterine musculature called utero placental apoplexy
34
Presenting complaints
Undue weight gain H/ o taking anti hypertensive drugs C/ o of swelling - oedema Site : dependent parts- ankle, feet and below knee, ll Non dependent parts- hands, abdominal wall, face, presacral, vulva Duration and whether it disappears with rest Rule out other causes of eoedema- anaemia, CVD, LD, hypoproteinemia, renal disease, dvt Decreased urine output and diminished fetal movements, painful bleeding pv
35
Imminent symptoms of preeclampsia
Headache, visual disturbances, giddiness, epigastric pain- stretching of liver capsule, decreased urine output
36
Proteinuria
Is defined as presence of more than 0.3g/L in 24 hrs urine or 1g/L in random specimen at two different times
37
Grading of thrombocytopenia
Grade 1- > 100,000 Grade 2- 50,000- 100,000 Grade 3- < 50000
38
Pre eclampsia
Blood pressure more than 140/90 after 20weeks of gestation in a previously normotensive woman along with proteinuria ( >0.3g/l in 24 hrs)
39
Severe pre eclampsia
Blood pressure of 160/110mmhg, along with imminent symptoms of headache, visual disturbance, giddiness, epigastric pain and decreased urine output. Proteinuria>0.3 g/ l 24hrs +2 Oliguria - <400ml / 24hr Platelet< 100,000 Serum creatinine>1.1 Fundus changes - grade 3 , 4
40
Eclampsia
Occurrence of convulsions in a patient with preeclampsia with no coincidental neurological disease
41
Pathophysiology of preeclampsia
Vasospasm- imbalance between vasodilators pgI2, NO and vasoconstrictors pgE2 , endothelin Endothelial dysfunction and damage - release of cytokines and interleukins Pathophysiology - incomplete secondary invasion of cytotrophoblasts into spiral arteries on the myometrium - improper vascular remodeling and placental perfusion
42
Predictors of preeclampsia
Mean arterial pressure> 90mmhg predicts, > 105mmhg diagnostic Gants roll over test - if the increase diastolic blood pressure> 20mmhg when patient lies in supine from left lateral position Renal dysfunction - serum uric acid, microalbuminuria, urinary calcium, thromboxane Platelet count
43
Management of eclampsia
Admit in HDU Railed cot O2 Clear air way Insert mouth gag Continuous bladder drainage Input output chart Antibiotics Anti hypertensive management Labetalol - IV bolus of 20,40,80 mg every 10mins, total 300 mg followed by 2mg/min infusion
44
Maternal complications of pre eclampsia
Eclampsia Preterm labour Abruptio placenta Oliguria and anuria- renal failure Papilledema, cortical blindness Retinal detachment HELLP syndrome Cerebral haemorrhage CCF
45
Foetal complications
FGR, IUD, prematurity and intrapartum haemorrhage
46
APH
Defined as bleeding from genital tract after 28 weeks of gestation before delivery of foetus Causes - abruptio placenta, placenta previa, vasa previous, circumvallate placenta, rupture of marginal sinus
47
Page classification of abruptio placenta
0- retro placental clots seen after delivery 1- mild bleeding, no uterine tetany, no foetal or maternal distress 2- possible external bleeding, uterine tetany and tenderness, foetal distress 3- uterine tetany, IUD, maternal complications

Obg Practicals (10 decks)

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