hypertension in pregnancy Flashcards
(40 cards)
hypertension in pregnancy is defined as what?
> 140/90mmHg on 2 occasions or
160/110mmHg
3 types of hypertension?
- pre-existing/chronic hypertension
- gestational hypertension
- pre-eclampsia
if women comes into booking appointment with hypertension what is she considered to have?
- chronic hypertension
what secondary causes can you consider in hypertension presenting for the first time?
- renal/cardiac
- cushing’s
- conn’s
- phaeochromocytoma
risks of hypertension in pregnancy?
- PET 2x
- fetal growth restriction
- abruption
what cardiac medications are women recommended to avoid while trying to get pregnant?
- ACE
- ARB
- thiazide diuretics
> teratogenics
what is gestational hypertension?
- hypertension seen in second half of pregnancy and resolves 6/52 of delivery
how many women w gestational hypertension can progress on to pre-eclampsia
- 15%
- depends on gestation
Mx for chronic/GH
- timing of birth dependent on clinical condition
- aim to deliver women > 37 weeks
- monitor BP daily after birth
- aim to keep BP < 130/80
- continue antihypertensives - review 2 weeks post natal by GP
- further review 6-8 weeks post natal
- stop methyl dopa within 2 days
what is pre-eclampsia?
- pregnancy specific multi system disorder
- may be asymptomatic at time of first presentation
- diffuse vascular endothelial dysfunction widespread circulatory disturbance
- renal/hepatic/CV/haem/CNS/placenta
pre-eclampsia clinical signs
- hypertension
- proteinuria (UPCR >30mg/mmol)
- oedema
- absence does not exclude diagnosis
early pre-eclampsia is before when?
< 34 weeks
late pre-eclampsia is when?
> 34 weeks
- 9/10 women present with late pre-eclampsia vs early pre-eclampsia
does pre-eclampsia have genetic or environmental predisposition?
- yes - if in family more likely to get it
- risk inc 3x if mother of sister has PET
what are 2 stages in pathogenesis of pre-eclampsia?
- abnormal placental perfusion
placental ischaemia - stage 2 - maternal syndrome
anti-angiogenic state assoc w endothelial dysfunction
describe process of trophoblast invasion during pregnancy
- trophoblast invasion from placenta into spiral artery
- loss of muscle layer of spiral artery
- more blood flow/nutrition/blood going to baby
> failure of trophoblast invasion - endothelial damage - platelet aggregation - placental ischaemia and infarction - causing hypertension
HELLP syndrome stands for what?
- haemolysis
- elevated liver enzymes
- low platelets
has a high morbidity/mortality
how does liver disease related to pre-eclampsia present?
epigastric/RUQ pain
abnormal liver enzymes
hepatic capsule rupture
symptoms of pre-eclampsia?
- headache
- visual disturbance
- epigastric/RUQ pain
- nausea/vomiting
- rapidly progressive oedema
- lack of fetal movement
signs of pre-eclampsia
- hypertension
- proteinuria
- oedema
- abdominal tenderness
- disorientation
- small for gestational age fetus
- intrauterine fetal death
- hyper-reflexia/involuntary movements/clonus (check CNS)
investigations for pre-eclampsia?
- U+Es
- serum urate
- liver function tests
- FBC
- coagulation screen -> DIC
- urine protein creatinine ratio (UPCR)
- carditocography
- US - fetal assessment
women at high risk of PET are?
- hypertensive during px pregnancy
- CKD
- AI - SLE or APS
- type 1 or 2 DM
- chronic hypertension
> recommend 75-100mg aspirin daily from 12 weeks until birth of baby
moderate risk factors of pre-eclampsia
- nulliparity
- > 40
- interval between pregnancies of more than 10 years
- BMI of 35 or more at first visit
- FH of pre-eclampsia
- 1 or more also given aspirin
in tayside how much low dose aspirin is given to women with high risk/ 1 or more mod risk factors for pre-eclampsia?
- 150mg dose from 12 weeks
