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Flashcards in Hypertension Deck (28)
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1
Q

What is the normal course of blood pressure in a pregnancy individual?

A

Decreases in the early stages, low at 22 weeks
Gradually increases again until delivery
Will see a drop PP but again rise and peak at 2-4 days PP

2
Q

What percentage of people will get hypertension in pregnancy?

A

10-15%

3
Q

Who is most commonly affected by pre-eclampsia

A

primagravida

4
Q

What meets the criteria for hypertension in pregnancy?

A

> 140/90 on 2 occassions
160/110 on 1 occassion
30/15 from first trimester

5
Q

What is the criteria for pre-clampsia?

A

Hypertension, oedema and proteinuria

6
Q

When is hypertension considered to not be related to pregnancy?

A

Diagnosis before pregnant or maintained hypertension for > 3months

7
Q

How will most present with pre-eclampsia?

A

Asymptomatic - picked up at antenatal screening

8
Q

What is classified as early and late pre-eclampsia?

A
Early = < 34 weeks (if less than 20 weeks then investigate for other pathology)
Late = > 34 weeks (majority of cases)
9
Q

Is pre-eclampsia a multisystem disease?

A

YES - it can involve the CV, CNS, pulmonary, renal, hepatic, haematological, and placental circuits

10
Q

Explain the renal involvement in pre-eclampsia

A

decreased GFR, altered U&Es, oligouria/anuria, serum urate elevated, AKI (acute tubular necrosis, cortical necrosis)

11
Q

Explain the liver involvement in pre-eclampsia

A

RUQ pain, LFTs deranged, can have hepatic capsule rupture and HELLP syndrome develop

12
Q

What is HELLP syndrome?

A

Haemolysis
Elevated Liver enzymes
Low Platelets

13
Q

Explain the CNS involvement in pre-eclampsia?

A

Clonus, cerebral oedema, cortical blindness, hypertensive encephalopathy, intracranial haemorrhage, CN palsy

14
Q

Explain the CVS/pulmonary involvement in pre-eclampsia

A

pulmonary oedema - can lead to ARDS

15
Q

Explain the haematological involvement in pre-eclampsia

A

reduced PV, thrombocytopenia, DIC, haemolysis

16
Q

Explain the placental involvement in pre-eclampsia

A

FGR, IUD or placental abruption

17
Q

How is pre-eclampsia investigated?

A

U&E, serum urate, LFTs, FBC, coag, BP, urine PCR, CTG, USS

18
Q

How is pre-eclampsia managed?

A

Control BP (methyldopa or labetolol), monitor for changes, give prophylactic steroids

19
Q

If have risk factors for pre-eclampsia then what can be done to reduce risk?

A

LDA (75mg) from 12 weeks until birth

20
Q

What are some risk factors for pre-eclampsia?

A

Previous in past pregnancy, >40 yrs, BMI >30, FHx, nulliparous (primagravida), multiple pregnancy

21
Q

What is the only way to treat pre-eclampsia?

A

Delivery of foetus

22
Q

What are symptoms/signs of pre-eclampsia?

A

hypertension, oedema, proteinurea, headache, visual disturbance, disorientation, RUQ pain, N+V, SGA, FGR, IUD

23
Q

What is eclampsia?

A

This is a generalised tonic clonic that may present before the onset of hypertension/proteinurea

24
Q

When can eclampsia present?

A

antepartum (38%)
intrapartum (16%)
postpartum (44%)

25
Q

How do you manage eclampsia - control of BP?

A

IV labetolol and IV hydralazine

26
Q

How do you manage eclampsia - control seizure?

A
IV MgSO4 
loading dose = 4g
maintenance dose = 1g/hr
if another seizure then give 2g MgSO4
if another after that then give 10mg IV diazepam
27
Q

How do you manage eclampsia - delivery?

A

aim for vaginal with epidural - avoid ergometrine

28
Q

How do you manage eclampsia - fluids?

A

It is better to run a patient dry as the risk of fluid overload and pulmonary oedema is high.