Hypertension and Pre-ecampsia Flashcards
(35 cards)
define pre-eclampsia (3 parts to the definition)
hypertension…
…occurring after 20 weeks gestation…
…with associated end organ damage
triad of pre-eclampsia
hypertension
proteinuria
oedema
define pregnancy induced hypertension
therefore the difference with this and pre-eclampsia is..
new onset HTN after 20 weeks gestation
the difference is the presence/absence of end organ damage
what is eclampsia?
seizure occurring in a patient with known pre-eclampsia
what is the basic pathophysiology that leads to gestational HTN and pre-eclampsia?
failure of the development of placental lacunae
the placenta doesn’t get enough blood and this causes oxidative stress
the placenta releases inflammatory signals into the mother’s circulation and this impairs endothelial function
5 high risk factors for pre-eclampsia
previous pre-eclampsia or gestational HTN
pre-existing HTN
pre-existing autoimmune conditions (such as SLE)
diabetes
CKD
6 moderate risk factors for pre-eclampsia
multiple pregnancy
first pregnancy
more than 10 years since last pregnancy
BMI >35
age >40
FHx of pre-eclampsia
patients are offered aspirin from 12 weeks gestation if they have how many high or moderate risk factors?
all patients with any high risk factor
all patients with 2 or more moderate risk factors
for prophylaxis of pre-eclampsia, aspirin is given from 12 weeks gestation until
birth
7 signs/symptoms of pre-eclampsia
headache blurred vision/vision changes upper abdominal pain (liver swelling) N+V oedema
reduced urine output
brisk reflexes
diagnosis of pre-eclampsia can be made with (1 + 1/3)
Systolic of 140 or diastolic of 90 PLUS
proteinuria 1+ or more on dipstick OR
organ dysfunction OR
placental dysfunction
5 ways that organ dysfunction may manifest in pre-eclampsia (other than proteinuria)
raised creatinine
raised LFTs
low platelets
haemolytic anaemia
seizures
2 ways that placental dysfunction can present in pre-eclampsia
foetal growth restriction
abnormal doppler studies
abnormal proteinuria:
protein/creatinine
albumin/creatinine
30mg/mmol
8mg/mmol
what is the use of taking a placental growth factor between 20 and 35 weeks?
it can be used to rule out pre-eclampsia if it is normal
what will the PlGF be in pre-eclampsia?
low (PlGF stimulates the development of new blood vessels - therefore if it is low this suggests that new blood vessels are not developing)
at what blood pressure are pregnant patients admitted for antihypertensives?
160/110
uggest 3 additional screening measures that patients with gestational hypertension will have
weekly urine dip for protein
foetal growth will be assessed with serial scans
FBCs and LFTs weekly to check for other manifestations of organ dysfunction
2 scoring systems for the severity of pre-eclampsia
fullPIERS
PREP-S
how frequently should blood pressure be taken in patients with pre-eclampsia?
every 48 hours at least
true or false: urine dipstick should be performed every 48 hours in patients with pre-eclampsia
false - there is no need to do a urine dipstick on patients who are already diagnosed with pre-eclampsia
how is the health of the foetus monitored in patients with pre-eclampsia?
USS and dopplers to check foetal growth and amniotic fluid every 2 weeks
first, second and third line antihypertensives in pregnancy
labetalol
modified release nifedipine
methyldopa
which antihypertensive is likely to be given in the management of pregnant patients with malignant hypertension?
IV hydralazine
